Uniportal thoracoscopic decortication in the treatment of chronic tuberculous empyema / 中华胸心血管外科杂志

Objective:To investigate the surgical procedure and outcome of uniportal thoracoscopic decortication in the treatment of chronic tuberculous empyema.Methods:From March 2019 to December 2019, the clinical data of 53 patients with chronic tuberculous empyema, who underwent uniportal thoracoscopic decortication in the Surgical Department of Wuhan Pulmonary Hospital were retrospectively analyzed. There were 40 males and 13 females. Age ranged from 16 to 69, averaged 36 years old.36 cases were on the right side and 17 cases on the left side, 38 cases were complicated with pulmonary tuberculosis. All cases had been diagnosed as tuberculous empyema by pathogeny and pathology test in preoperative or postoperative, and received tuberculosis management treatment between 2 and 12 months prior to surgery.The surgical procedure and clinical efficacy of uniportal thoracoscopic decortication were expounded in treatment of chronic tuberculous empyema.Results:Among the 53 patients, 49(92.45%) cases underwent uniportal thoracoscopic decortication, and 4(7.55%) cases changed to thoracotomy. The duration of surgery was 100-370 min, mean(234.53±56.06)min. Intraoperative hemorrhage was 50-1 400 ml, median value 300(175.0, 402.5)ml. Catheter retention time was 3-22 days, median value 8(6.00, 11.25)days. The incidence of surgical complications was 1.89%(1/53), the cure rate was 92.45%(49/53).Conclusion:If the perioperative evaluation and treatment are appropriate, and the operator is experienced, the uniportal thoracoscopic decortication is feasible, safe and effective in the therapy of chronic tuberculous empyema.

The status of knowledge of sudden cardiac death prevention among general practitioners / 中华全科医师杂志

Objective:To survey the knowledge levels of sudden cardiac death (SCD) prevention among general practitioners (GPs) in Henan province.Methods:From October to November 2019, a questionnaire survey on the knowledge of SCD prevention and treatment was conducted among GP residents participating in the standardized training and assistant GPs taking final examination after training in Henan province. The questionnaire included three dimensions of SCD knowledge: prevention, early diagnosis and first aid. The factors influencing the knowledge levels on SCD prevention were analyzed.Results:A total of 546 questionnaires were distributed and 519 responders (95.1%) completed the questionnaire, including 176 GP residencies and 343 assistant GPs. The age of the respondents was 22-44 (27.91±2.84) years, 234 (45.1%) were males and 285 were females. The overall correct rate of SCD prevention and treatment was (61.46±12.39) %, and the correct rates of prevention, early diagnosis and first aid knowledge were (65.22±17.88)%, (56.58±20.20)% and (62.57±14.60)%, respectively. The overall correct rate and the correct rates of SCD prevention and treatment knowledge among GP residents were higher than those among assistant GPs ( t=10.55, 9.20, 8.62, 3.42, P<0.001); the overall correct rates and the correct rates of SCD first aid knowledge of female GPs were higher than those of males ( t=2.26, 2.13, P=0.025, 0.033); the overall correct rate and the correct rates of each dimensions in age group ≥28 years were higher than those in age group <28 years ( t=4.21, 3.37, 3.20, 2.00, P<0.05). The multivariate logistic regression analysis showed that compared to GP residents,the assistant GPs was the factor influencing the lower levels of the overall knowledge ( OR=0.24, 95 %CI:0.16-0.38, P<0.001), knowledge of prevention ( OR=0.19, 95 %CI:0.10-0.32, P<0.001) and knowledge of early diagnosis ( OR=0.35, 95 %CI: 0.23-0.52, P<0.001);compared to male responders,the females had significantly higher pass rate in SCD first aid knowledge ( OR=1.56, 95 %CI:1.07-2.28, P=0.020). Conclusions:The SCD knowledge levels of the prevention, early diagnosis, and emergency treatment are less satisfactory among GPs in Henan province; it is necessity for targeted training on the weak points of SCD knowledge for GPs.

Role of long non-coding RNA 068 in the migration of melanoma cells / 中华皮肤科杂志

Objective:To investigate the effect of long non-coding RNA 068 (lncRNA 068) on the migration of a melanoma cell line A375, and to explore its mechanism of action.Methods:From December 2015 to November 2020, 21 patients with pathologically confirmed cutaneous melanoma were collected from Department of Dermatology, Affiliated Hospital of Nantong University, and quantitative PCR (qPCR) was performed to determine the expression of lncRNA 068 in melanoma and paracancerous tissues. LncRNA 068 was overexpressed or knocked down via lentiviral transfection in A375 human melanoma cells in the following experiments. Specifically, A375 cells were divided into lentiviral vector (LV) -green fluorescent protein (GFP) group and LV-lncRNA 068 group to be transfected with a GFP-expressing LV and a LV containing lncRNA 068 respectively in the overexpression experiment, and were divided into LV-LacZ short hairpin RNA (shRNA) group and LV-lncRNA 068 shRNA group to be transfected with a LV containing the reporter gene LacZ-specific shRNA and a LV containing the lncRNA 068-targeting shRNA respectively in the low-expression experiment, with the LV-GFP group and LV-LacZ shRNA group serving as the control groups. Transwell and scratch assays were performed to evaluate cell migration, EdU cell proliferation assay and cell counting kit-8 (CCK8) assay to determine the proportion of proliferative cells and cell viability respectively, and immunofluorescence staining was conducted to evaluate epithelial-mesenchymal transformation in the above groups. Lentivirus-transfected A375 cells from the above groups were inoculated into the axillae of BALB/c nude mice, and tumor volume was measured and calculated every 3 days. After 30 days, all mice were sacrificed, and tumor tissues were resected to measure the tumor volume and weight. Cultured B16F10 cells were subcutaneously inoculated into the back and foot of BALB/c nude mice to construct mouse models of subcutaneously transplanted B16F10 melanoma. After 2 weeks, the mice were sacrificed, and qPCR and Western blot analysis were performed to determine the mRNA expression of inflammatory factors in transplanted B16F10 melanoma and paracancerous tissues, and expression of IκB kinase (IKK) /P65 signaling pathway-related proteins, respectively. Comparisons between 2 groups were done by t test, and comparisons of tumor volume and weight at different time points among groups were done by repeated measures analysis of variance. Results:qPCR showed that the relative expression of lncRNA 068 was significantly lower in human melanoma tissues and transplanted B16F10 murine melanoma tissues (0.414 ± 0.109, 0.717 ± 0.041, respectively) than in the corresponding paracancerous tissues (1.050 ± 0.103, 1.011 ± 0.023, t = 19.48, 10.83, respectively, both P < 0.001). Transwell and scratch assays both showed that the cellular migratory ability was significantly lower in the LV-lncRNA 068 group than in the LV-GFP group (both P < 0.01), and significantly higher in the LV-lncRNA 068 shRNA group than in the LV-LacZ shRNA group (both P < 0.05). Immunofluorescence assay showed significantly increased fluorescence intensity of E-cadherin and decreased fluorescence intensity of N-cadherin in the LV-lncRNA 068 group compared with the LV-GFP group (both P < 0.001), but significantly decreased fluorescence intensity of E-cadherin and increased fluorescence intensity of N-cadherin in the LV-lncRNA 068 shRNA group compared with the LV-LacZ shRNA group (both P < 0.05). In vivo tumor formation experiment in nude mice showed that there were no significant differences in the volume or weight of melanoma between the LV-lncRNA 068 group and LV-GFP group (both P > 0.05), as well as between the LV-lncRNA 068 shRNA group and LV-LacZ shRNA group (both P > 0.05). As qPCR and Western blot analysis showed, the mRNA and protein expression of interleukin-10 (IL-10) and claudin-1 in A375 cells were significantly higher in the LV-lncRNA 068 group than in the LV-GFP group (both P < 0.05), but significantly lower in the LV-lncRNA 068 shRNA group than in the LV-LacZ shRNA group (both P < 0.05). Compared with the paracancerous tissues, B16F10 melanoma tissues showed significantly decreased mRNA expression of IL-10 ( P < 0.01), but significantly increased mRNA expression of IL-6 and tumor necrosis factor-α, as well as protein expression of phosphorylated P65 and phosphorylated IKK ( P < 0.01) . Conclusion:Overexpression of lncRNA 068 can inhibit the migration of A375 melanoma cells, and may affect the development of inflammation and inhibit the epithelial-mesenchymal transformation by inhibiting the IKK/P65 signaling pathway.

LMX1B-associated disease presented with prominent asymptomatic proteinuria / 中华实用儿科临床杂志

Objective:To analyze clinical data of 3 children with LMX1B-associated disease characterized by asymptomatic glomerular proteinuria, thus improving the recognition of asymptomatic proteinuria with genetic causes. Methods:Three patients with LMX1B-associated disease presented with prominent asymptomatic proteinuria diagnosed by the next-generation sequencing in Department of Pediatrics, Peking University First Hospital from April 2014 to October 2017 were included in this study.Clinical data, including renal and extrarenal manifestations, renal biopsy, and family history, were collected and retrospectively analyzed. Results:All 3 children were girls, the age of onset were 2 years, 1 year, and 4 years, respectively, and the diagnosis age were 11 years, 5 years and 6 years, respectively.All of them had glomerular proteinuria, and nephrotic-level proteinuria occurred in one patient.Microscopic hematuria was found in 2 patients.All of them had normal renal function.Only one patient underwent renal biopsy.Electron microscopy of the first time of biopsy revealed segmental thinning of the glomerular basement membrane.Re-biopsy 4 years later showed irregular thickening of the glomerular basement membrane, moth-eaten appearance and collagen fibrillar material deposition.No abnormalities of nails, limbs and joints were observed by physical examination.Two patients had a family history of renal disease.Conclusions:Genetic factors should be considered in children with obscure onset asymptomatic proteinuria without definite clinical causes.Genetic testing can help diagnose and guide treatment as early as possible.

Effects of different lipid-lowering regimens on endothelial function and safety in patients with unstable angina / 中华急诊医学杂志

Objective:To investigate the effects of different lipid-lowering regimens on blood lipids, endothelial function and safety in patients with unstable angina.Methods:Patients who admitted to Henan Provincial People's Hospital for unstable angina from September 2018 to May 2019 were randomly (random number) divided into the conventional treatment group, intensive statin group and intensive lipid-lowering group. Follow-up was performed at 1, 3, and 6 months after treatment according to the predetermined lipid-lowering regimen. Assessments included lipid profile, liver function, muscle enzymes, hypersensitive C-reactive protein (hs-CRP), endothelial function (reactive hyperemia index, RHI), ischemic events, myalgia, and discontinuation. The differences of the follow-up indicators among the three groups were analyzed.Results:A total of 375 patients were enrolled and randomly divided into three groups, 125 patients in each group. There were no significant differences in demographic data and medication among the three groups. At the 1st month, the low density lipoprotein cholesterin (LDL-C) compliance rate of the intensive statin group was significantly higher than those in the conventional treatment group ( χ2=3.939, P=0.047) and the intensive lipid-lowering group ( χ2=4.63, P=0.031). At the 3rd month, the reductions of LDL-C in the intensive statin group and the intensive lipid-lowering group were significantly better than that in the conventional treatment group( P<0.01). At the 6th month, the reduction rate of LDL-C in the intensive lipid-lowering group was higher than that in the intensive statin group ( q=4.332, P<0.01). At the 1st month, the improvement of hs-CRP and RHI in the intensive statin group was significantly better than that in the conventional treatment group( q=4.133, P<0.05). From the 3rd month of treatment, the incidence of cardiovascular events in the intensive statin group and the intensive lipid-lowering group showed a tendency to decrease compared with the conventional treatment group, but no statistically significant difference was found. At the 6th months of treatment, the withdrawal rates were significantly higher in the intensive statin group and the intensive lipid-lowering group than that in the conventional treatment group (χ 2=4.488, P=0.03 and χ2=5.039, P=0.02). There were no significant differences in the ratio of liver enzyme and muscle enzyme elevation and the incidence of myalgia among the three groups (all P>0.05). Conclusions:Intensive statin therapy can make LDL-C reach the standard in patients with unstable angina pectoris as soon as possible, significantly improve inflammation indicators and endothelial function, and has good safety.

Insights into epigenetic patterns in mammalian early embryos

Mammalian fertilization begins with the fusion of two specialized gametes, followed by major epigenetic remodeling leading to the formation of a totipotent embryo. During the development of the pre-implantation embryo, precise reprogramming progress is a prerequisite for avoiding developmental defects or embryonic lethality, but the underlying molecular mechanisms remain elusive. For the past few years, unprecedented breakthroughs have been made in mapping the regulatory network of dynamic epigenomes during mammalian early embryo development, taking advantage of multiple advances and innovations in low-input genome-wide chromatin analysis technologies. The aim of this review is to highlight the most recent progress in understanding the mechanisms of epigenetic remodeling during early embryogenesis in mammals, including DNA methylation, histone modifications, chromatin accessibility and 3D chromatin organization.

Curative effect analysis of decortication in the treatment of durg-resistant tuberculous empyema / 中华胸心血管外科杂志

Objective:To investigate the risk and efficacy of the decortication in treatment of drug-resistant tuberculous empyema.Methods:A retrospective analysis was conducted on the 146 patients with tuberculous empyema, who underwent decortication in Wuhan Pulmonary Hospital from March 2016 to November 2018, according to the drug-susceptibility testing of the pleural effusion or tissue specimens, the patients had been divided into drug-resistant group(29 cases) and control group(117 cases), compared the clinical datas such as operation time, intraoperative blood loss, postoperative drainage duration, pulmonary reexpansion duration, postoperative complications and curative ratio between both groups, and the factors that influence the risk and efficacy of surgery had been analyzed.Results:The operative time, intraoperative blood loss, postoperative drainage duration and postoperative complications in the drug-resistant group were larger than those in the control group, and the differences were statistically significant ( P<0.05). There was no significant difference in pulmonary reexpansion duration and curative ratio in the two groups( P>0.05). Conclusion:Decortication is safety, effective and feasible in the treatment of drug-resistant tuberculous empyema, although the operation is difficult and risky.

SWOT analysis on the involvement of general practitioners in prevention and control system of sudden cardiac death / 中华全科医师杂志

Sudden cardiac death (SCD) is one of the most common causes of death for patients with cardiovascular diseases. General practitioners are the providers of primary medical and health service, it its worthwhile to discuss their role positioning in the prevention and control system of SCD. In this study, SWOT analysis was used to explore the strength, weakness, opportunity and threats of the involvement of general practitioners in SCD prevention and control system, to clarify the roles of general practitioners and to provide suggestions for the improvement and development of SCD prevention and control system in China.

Survey on knowledge, attitude and prescribing of benzodiazepines among general practitioners / 中华全科医师杂志

Objective:To survey on the knowledge, attitude and prescribing of benzodiazepines (BZDs) among general practitioners.Methods:A questionnaire survey was conducted in November 2018 among 396 clinicians who participated in the general practice training in Henan Province, including 131 general practitioners (GP group) and 265 non-GPs (non-GP group). The questionnaire included basic information of clinicians, BZDs prescription and training, subjective attitude and knowledge of BZDs.Results:The results of 396 valid questionnaires showed that 55 (13.9%) clinicians had participated in BZDs related training, and 331 (83.6%) clinicians had prescribed BZDs. There was no significant difference in the duration of BZDs continuous use between the GP group and the non-GP group (χ 2= 8.37, P>0.05). The overall score of subjective attitude towards BZDs was low [4(2,6) - 5(3,9)], and the score of BZDs training needs was high [10(8,10)]. Compared to non-GP group, the GP group had lower confidence in BZDs indication [4(2,6) vs. 5(3,6), Z=-2.66, P<0.05 ], the lower ability of judging BZDs addiction [5(2,6) vs. 5(3,7), Z=-2.52, P<0.05], and less understanding of BZDs use guidelines [4(1,5) vs. 4(3,6), Z=-3.05, P<0.05]. In terms of prescription tendency, the GP group was less inclined to prescribe BZDs according to experience [5(2,7) vs. 6(4,8), Z=-3.50, P<0.05]. In the knowledge of BZDs, the total score of GP group was lower than that of non-GP group, the [11(8,12) vs. 11(9,13), Z=-2.06, P<0.05]. The proportion of GPs with drug addiction recognition[66.4%(87/131) vs.77.7%(206/265),χ 2=5.84] and pharmacology knowledge [59.5%(78/131) vs.72.1%(191/265),χ 2=6.32] were all lower than that of non-GPs( P<0.05). Conclusions:General practitioners are lack of knowledge about BZDs and confidence in prescribing BZDs. It is necessary to carry out training on BZDs, especially for addiction and drug effects.

Efficacy of hemostatic powder on preventing delayed bleeding after endoscopic submucosal dissection: a randomized controlled trial / 中华消化内镜杂志

Objective:To evaluate the efficacy of hemostatic powder on preventing delayed bleeding after endoscopic submucosal dissection (ESD).Methods:Patients who received ESD in the First Affiliated Hospital of Soochow University and Yulin No.2 Hospital from June 2017 to August 2018 were enrolled with informed consents, and randomly divided into the study group and the control group. Hemostatic powder was applied on post-ESD ulcer after routine hemostasis method in the study group, and the control group was given routine hemostasis method only. The time and dosage of hemostatic powder spraying and its adverse events were observed in the study group. The operation time, rate of delayed bleeding (within 30 days after operation) and early delayed bleeding (within 48 hours after operation), and postoperative hospital stay were compared between the two groups.Results:A total of 196 patients were enrolled including 97 in the study group and 99 in the control group. The baseline data were comparable between the two groups (all P>0.05). In the study group, the time to spray powder was 68.78±19.75 s, dosage was 2.51±0.93 g. Powder delivery catheter was blocked in one case (1.03%, 1/97). No adverse event was reported during 30 days of follow-up. The operation time was not statistically different in the study group and the control group (61.92±11.71 min VS 59.76±11.01 min, t=1.330, P=0.185). The delayed bleeding rate of the study group was significantly lower than that of the control group [1.03% (1/97) VS 8.08% (8/99), P=0.035]. There was no case of early delayed bleeding occurred in the study group, while 6 cases (6.06%, 6/99) in the control group ( P=0.029). The postoperative hospital stay was not statistically different between the study group and the control group (4.57±0.85 d VS 4.86±1.37 d, t=1.778, P=0.077). Conclusion:Although capacity of hemostatic system remains to be improved, hemostatic powder is an effective, safe and simple method to reduce delayed bleeding rate after ESD, especially on early delayed bleeding.

Status of general practice residency training and career choice of trainees in Henan Province / 中华全科医师杂志

Objective:To survey the status general practice residency training and career choice of trainees in Henan Province.Methods:From December 2017 to February 2018, 332 trainees from the first general practice residency training program (2014-2017) were enrolled in the study. The self- administered questionnaire included the demographic information and the current career status. The logistic regression model was used to analyze the influencing factors of the career choice when their completed the training.Results:Of 332 participants, there were 167 participants designated by the institutions and the others were directly enrolled by the program. The designated participants were from the 56 medical institutions in Henan. The percentage of participants from the tertiary hospitals was 75.5% (126/167), which was much higher than that from the secondary hospitals (24.5%,41/167). There were 24 participants who did not have a work six months after graduation. Of the 308 employed participants, there were only 111 (36.0%, 111/308) working in the department of general practice, and 197 (64.0%, 197/308) working in other departments. The participants designated by the institutions and with the post-graduate degrees preferred to choose other specialties, instead of the general practice. The reasons were that there was no department of general practice in their institutions or the participants had been designated to the other departments (57.9%, 114/197).Conclusion:The survey suggests that the general practice residency training program should enroll trainees mainly from the medical graduates in order to improve the effectiveness of general practitioner residency training and the allocation of health resources in Henan Province.

Bibliometric analysis on international cooperation of rehabilitation robots in China from 2000 to 2019 / 生物医学工程学杂志

Rapid development is undergoing in the field of rehabilitation robots, and more countries (regions) are participating in international cooperation and becoming academic contributors. Here in this study, the bibliometric method is used to determine the dynamics and developments of international cooperation in China. The publication data are indexed in Web of Science with search term of rehabilitation robot from 2000 to 2019. Compared with other countries (regions), publication with international co-authors and institutes participating in international cooperation are studied by assessment of indicators such as the cooperation degree, cooperation frequency, and the frequency of citations. The results show that in the past two decades, international scientific cooperation has shown a positive tendency in China, and participating in international collaboration could improve China's impact on the global rehabilitation robot. The United States, England and Japan are the top three countries in number of cooperation with China. Our findings provide valuable information for researchers to better understand China's international scientific collaboration in rehabilitation robot.

Clinical features and prognostic factors of primary gastric neuroendocrine neoplasms / 中华内科杂志

Objective:To study the clinical characteristics and classification of gastric neuroendocrine neoplasm(NEN) and prognostic factors of mixed adenoneuroendocrine carcinoma (MANEC) and gastric neuroendocrine carcinoma(NEC).Methods:A total of 148 gastric NENs were divided into type Ⅰ, type Ⅱ and type Ⅲ based on the classification of European Neuroendocrine Tumor Society (ENETS). Kaplan-Meier test and Cox regression model were used in univariate and multivariate survival analysis in 108 cases with pathological G3 gastric NEN.Results:In this study, the percentages of type Ⅰ, type Ⅱ and type Ⅲ were 25.0%(37), 3.4%(5) and 71.6%(106) respectively. Among type Ⅰ patients, 28(75.7%) lesions were located in gastric fundus or body, 29(78.4%) had bumps. Lymph node involvement was found in 4 (10.8%) patients. Twenty-six (70.3%) patients received endoscopic treatment and 11 (29.7%) with surgery. All 5 type Ⅱ patients presented lesions in gastric fundus or body, including 4 with ulcers, who were all treated by endoscope. Three type Ⅱ patients had gastrinoma, and 2 combined with multiple endocrine neoplasmⅠ. In type Ⅲ patients, 56(52.8%) showed ulcerative lesions. The majority of patients (102, 96.2%) had a single lesion, 94(88.7%) with lymph node or other organ metastasis. In this study, no deaths were reported in gastric NEN with a pathological grade of G1 or G2. The mortality rate was 38.9%(42/108) in patients with G3 NEN. Survival analysis suggested that age, metastasis of tumor were associated with poor prognosis ( P=0.041, 0.025). Conclusions:Patients with gastric NEN have heterogenous clinical presentations according to gender, age, endoscopic features, infiltration and metastasis, and pathological grade. Aging and metastasis are negative prognostic factors of G3 gastric NEN.

The relationship between plasma homocysteine and renal dysfunction in elderly patients with coronary heart disease / 中华老年医学杂志

Objective:To explore the relationship between plasma homocysteine level and renal dysfunction in elderly patients with coronary heart disease(CHD).Methods:Eight hundreds and fifty-eight elderly patients with CHD were enrolled at cardiology department of our hospital from January 2015 to July 2017.The patients were divided into the renal insufficiency(RI, defined as an estimated glomerular filtration rate(eGFR)<60 ml/min)group and the non-kidney disease(NKD)group.Using the random number table, the RI group was randomly sub-grouped into the intervention group and the placebo group.The intervention group was treated with folic acid(10 mg/d), vitamin B6(10 mg/d)and vitamin B12(1 mg/d), while the placebo group was given oral placebo.Serum homocysteine(Hcy), creatinine(Cr), blood urea nitrogen(BUN), total cholesterol(TC), triglyceride(TG)and hemoglobin(Hb)were measured by enzyme-linked immunosorbent assay.Pearson correlation was used to analyze the correlations of Hcy with Cr, BUN and eGFR between the RI and NKD groups.Plasma Hcy, Cr, BUN and Hb levels before, and 6, 12 months after treatment were determined and compared between the two subgroups.Staging of renal function was analyzed and clinical effect was evaluated 12 months after treatment in the two subgroups.Results:Serum levels of Hcy, Cr and BUN were higher( t=3.174, 4.857 and 2.644, all P=0.000)and the level of eGFR was lower( t=-2.867, P=0.000)in the RI group than in the NKD group.Plasma Hcy level was positively correlated with plasma levels of Cr and BUN( r=0.308 and 1.214, all P=0.000)and negatively correlated with the eGFR level( r=-0.148, P=0.003). There was no significant difference in plasma Hcy, Hb, Cr and BUN levels between the intervention and placebo group before treatment( P>0.05). At each monitoring time point, serum levels of Hcy, Cr and BUN were decreased continuously in the intervention group( F=314.527, 234.861 and 176.332, P=0.012, 0.000 and 0.006), while plasma Hcy level had no significant change and plasma levels of Cr and BUN were increased continuously in the placebo group( F=196.427, 223.753 and 314.552, P=0.216, 0.000 and 0.002). After 12 months of treatment, plasma levels of Hcy, Cr and BUN were lower in the intervention group than in the placebo group( t=1.284, 0.779 and 2.541, P=0.016, 0.000 and 0.005). There was no significant difference in plasma Hb level between the two subgroups before and after treatment( F=113.764, P=0.182). There was no significant difference in the renal function staging between the two subgroups before treatment( χ2=4.263, P=0.119), while it was improved in the intervention group versus in the placebo group at the end of follow-up( χ2=73.599, P=0.000). Conclusions:The high level of plasma Hcy can be regarded as an independent risk factor for renal insufficiency, and has a correlation with the renal disease progression and prognosis in elderly patients with CHD.

Effectiveness and feasibility of health management cloud platform for people with high-risk of coronary heart disease / 中华健康管理学杂志

Objective:To evaluate the effectiveness and feasibility of health management based on cloud platform for population with high-risk of coronary heart disease (CHD).Methods:In this study, self-control method was used to study the high-risk group of CHD in two community outpatient clinics in Jinshui District, Zhengzhou through cloud platform. One year later, the clinical indicators, the degree of mastering CHD prevention knowledge andthe medicine compliance of the group were evaluated. Finally, the feasibility and acceptance of cloud platform management were evaluated through questionnaire survey.Results:A total of 272 people were enrolled intothe group. After one year of cloud platform management, the blood lipid, uric acid, homocysteine and fasting blood glucose in the group weresignificantly improved (all P<0.05), but the glycosylated hemoglobin was not significantly reduced [(6.4±1.2)% vs.(6.3±1.1)%, P>0.05]. The degree of mastering CHD prevention knowledgewas significantly improved, and the medicine compliance was not significantly improved [(5.0±1.6) vs. (5.0±1.5), P>0.05]. Questionnaire survey showed that 228 (83.8%) of the patients had a high acceptance of cloud platform management, and 208 (76.5%) of the group wanted to continue to use cloud platform for health management. Conclusions:Health management based on cloud platform can improve the clinical index control of the high-risk population of CHD, and help the high-risk population to master the relevant knowledge of CHD prevention. Some functions of cloud platform need to be further improved.

Comparison of fluoroscopy exposure between HIS bundle pacing and conventional pacing during procedures / 中华放射医学与防护杂志

Objective:To compare the differences of fluoroscopy time and dose between HIS bundle pacing and right ventricle apex pacing.Methods:This study includes thirty patients undergoing HIS bundle pacing (HIS group) and 32 patients undergoing right ventricular apex pacing (RVA group). The fluoroscopy time and cumulative dose (CD) to patients during surgery were recorded and analyzed.Results:The operation time for patients in HIS group and RVA group were (76.8±13.1) and (66.0±10.8) min ( t=3.386, P<0.001), respectively. The fluoroscopy time was (698.2±113.7) and (293.3±63.9) s ( t=14.709, P<0.001) and the CD were (391.3±70.0) and (162.3±40.5) mGy ( t=13.694, P<0.001) in HBP group and RVA group, respectively. In comparison, the fluoroscopy time and CD for HIS bundle electrode implantation were (501.2±112.3) s and (279.9±65.0) mGy, respectively, significantly higher than in the case of RVA, where the values were (103.4±30.6) s and (57.3±13.8) mGy ( t=15.864, Z=-6.524, P<0.001). Conclusions:Compared with right ventricular apical pacing, the HIS bundle pacing takes longer operation time, leading to higher radiation dose, which should be prudently selected.

Investigation on knowledge of sudden cardiac death among the general practitioners / 中国基层医药

Objective:To understand the knowledge situation of sudden cardiac death (SCD) among general practitioners (GPs) and provide the suggestions on the prevention and treatment of SCD basis for GPs.Methods:A self-designed questionnaire on SCD-related knowledge was used for GPs in He′nan province, including GPs in the training program and working in rural areas.The questionnaire included three dimensions of SCD-related knowledge on prevention, early diagnosis and emergency treatment.There were 5 questions for each dimension, with a total score of 15 points for all 15 questions.Statistical analysis was performed using t test, analysis of variance and Chi-square test. Results:A total of 124 GPs were included in the cross-sectional survey, including 63 GP trainers and 61 rural GPs.The GPs had the low level of SCD-related knowledge of prevention, early diagnosis and emergency treatment, with an overall score of 8.03 (SD=2.58). The score of GP trainers was significantly higher than that of rural GPs in all three dimensions [(3.44±0.89)points vs.(2.19±1.06)points, (2.67±0.91)points vs.(1.43±0.80)points, (3.54±0.94)points vs.(2.84±1.30)points, t=7.13, 8.11, 3.45, all P<0.001]. Rural GPs had a significantly higher correct rate of " choice of early screening examinations" and " first-aid measures for cardiac arrest" than GP trainers (50.8% vs.9.8%, 88.9% vs.26.2%, χ 2=24.79, 49.02, all P<0.001). Conclusion:GPs have low levels of SCD-related knowledge.The training for the GPs should be targeted on the weak points of knowledge on the primary prevention and secondary prevention of SCD.

Interpretation to " Consensus Guidelines for Perioperative Care in Neonatal Intestinal Surgery" by European Enhanced Recovery after Surgery Society in 2020 / 中华实用儿科临床杂志

On May 8, 2020, for the first time, European enhanced recovery after surgery(ERAS) society lunched Consensus Guidelines for Perioperative Care in Neonatal Intestinal Surgery, that provided 17 suggestions for intestinal resection surgery, including the selection of surgical method, the application of prophylactic antibiotics, the prevention of intraoperative hypothermia, perioperative fluid management, perioperative pain management, optimal hemoglobin, perioperative communication, parents involvement, postoperative nutrition care and mucous fistula refeeding.The guideline aims to recommend ERAS advices for neonatal intestinal surgery, so as to reduce perioperative adverse events, and improve medical quality as well as family satisfaction.Now, in order to provide the latest evidence-based information for the perioperative management practice of neonatal surgery in China, the author interpreted it.

Comparison on Asian Cancer Summit criteria and LI-RADS in diagnosis of hepatitis B inflammatory small hepatocellular carcinoma / 中国介入影像与治疗学

Objective: To compare Asian Oncology Summit (AOS, 2016) criteria and liver imaging reporting and data system (LI-RADS) in diagnosis of hepatitis B inflammatory small hepatocellular carcinoma(sHCC). Methods: Upper abdominal CT and MR examination were performed in 130 patients with suspected hepatitis B inflammatory sHCC (172 hepatic nodules with diameters ≤30 mm). Taken pathological results as the gold standards, the sensitivity and specificity of AOS standard and LI-RADS for diagnosis of hepatitis B sHCC were calculated. Results: ①For lesions with diameter ≤30 mm, the sensitivity and specificity of AOS criteria was 55.00% (44/80) and 92.39% (85/92), while of Li-RADS grading criteria was 100% (80/80) and 67.39% (62/92), respectively. ②For lesions with diameter <20 mm, the sensitivity and specificity of AOS criteria was 40.00% (10/25) and 94.34% (50/53), of Li-RADS grading criteria was 100% (25/25) and 71.70% (38/53), respectively. Conclusion: LI-RADS was more sensitive in diagnosis of hepatitis B inflammatory sHCC than AOS criteria, being helpful to early diagnosis and treatment.

The application of post cardiovascular surgery SOFA score in hospital mortality in severe patients / 中华胸心血管外科杂志

Objective Establish the post cardiovascular surgery SOFA score( pcvsSOFA) based on the Sequential Organ Failure Assessment( SOFA) score to evaluate the severity and prognosis of patients after cardiovascular surgery. Methods 3872 consecutive patients who underwent cardiovascular surgery and stayed in ICU more than 24 hours between July 2015 and December 2017 were retrospectively analyzed to establish a derivation cohort. Univariable and multivariable logistic regression were used to identify the predictors in the pcvsSOFA. And the validity of the new model was evaluated in the derivation cohort and validation cohort. Results Respiratory system score, coagulation system score, nervous system score and renal system score on the first day of ICU, Emergency surgery and re-surgery were risk factors and established the pcvsSOFA. The total score of pcvsSOFA was 20 point and was divided into four classes, namely class Ⅰ( pcvsSOFA-score:1-5 ) , class Ⅱ( pcvsSOFA-score:6-10 ) , class Ⅲ( pcvsSOFA-score:11-15 ) and class Ⅳ( pcvsSOFA-score:16-20 ) with their corresponding predicted mortality0.9％(n=2317),5.7％(n=1367),26.8％(n=184),and64.2％(n=4) inthederivationcohort. Thearea under the receiver operating characteristics curve(AUC)was 0. 864(95％CI:0. 837-0. 892), and the integrated discriminant improvement(IDI) was 0. 035. In the validation cohort, AUC(pcvsSOFA) = 0. 832(95％CI:0. 735-0. 928), IDI=0. 211. The AUC of SOFA, APACHE Ⅱ and SAPS Ⅱ was 0. 771, 0. 793 and 0. 721 respectively. Conclusion Compared with the SOFA score, pcvsSOFA could be a better tool to assess the prognosis of critical patients in the early postoperative stage.