Spatial and temporal analysis of MDR-TB epidemic based on SaTScan in Nanning in 2017 - 2021 / 公共卫生与预防医学

Objectives To analyze the spatial and temporal aggregation of multidrug resistant pulmonary tuberculosis (MDR-TB) incidence in Nanning at the township / street scale from 2017 to 2021, to explore the spatial and temporal characteristics of the spread of MDR-TB in Nanning, and to provide a scientific reference basis for the health administrative departments to achieve the precise implementation of MDR-TB prevention and control. Methods Based on the data of MDR-TB cases in Nanning from 2017 to 2021, the spatial-temporal scanning analysis software SaTScan v9.7 was used to retrospectively detect and analyze the areas where MDR-TB cases gathered. Results Through simple spatial scanning analysis, it was found that there were three first-class aggregation areas (the aggregation center was Fujiayuan Street, Jiangnan District, 2017, Xinyang Street, Xixiangtang District, 2019, and Zhonghe Town, Yongning District, 2020), and one second-class aggregation area (the aggregation center was Jinchai Town, Mashan County, 2020). Simple time scanning showed that the clustering occurred from May 2019 to December 2020. Temporal and spatial aggregation analysis showed that Xinyang Street in Xixiangtang District was the center of the first-class aggregation area, Zhonghe Town in Yongning District was the center of the second-class aggregation area, and Jinchai Town in Mashan County was the center of the third-class aggregation area. Conclusion The multidrug resistant pulmonary tuberculosis epidemic in Nanning is distributed in an aggregated manner, especially in Xinyang Street, Xixiangtang District, which has the highest spatial and temporal aggregation. It is necessary to focus on and take regional prevention and control measures to control the epidemic.

Multimorbidity Pattern and Risk for Mortality Among Patients With Dementia: A Nationwide Cohort Study Using Latent Class Analysis

Objective@#Individuals with dementia are at a substantially elevated risk for mortality; however, few studies have examined multimorbidity patterns and determined the inter-relationship between these comorbidities in predicting mortality risk. @*Methods@#This is a prospective cohort study. Data from 6,556 patients who were diagnosed with dementia between 1997 and 2012 using the Taiwan National Health Insurance Research Database were analyzed. Latent class analysis was performed using 16 common chronic conditions to identify mortality risk among potentially different latent classes. Logistic regression was performed to determine the adjusted association of the determined latent classes with the 5-year mortality rate. @*Results@#With adjustment for age, a three-class model was identified, with 42.7% of participants classified as “low comorbidity class (cluster 1)”, 44.2% as “cardiometabolic multimorbidity class (cluster 2)”, and 13.1% as “FRINGED class (cluster 3, characterized by FRacture, Infection, NasoGastric feeding, and bleEDing over upper gastrointestinal tract).” The incidence of 5-year mortality was 17.6% in cluster 1, 26.7% in cluster 2, and 59.6% in cluster 3. Compared with cluster 1, the odds ratio for mortality was 9.828 (95% confidence interval [CI]=6.708–14.401; p<0.001) in cluster 2 and 1.582 (95% CI=1.281–1.953; p<0.001) in cluster 3. @*Conclusion@#Among patients with dementia, the risk for 5-year mortality was highest in the subpopulation characterized by fracture, urinary and pulmonary infection, upper gastrointestinal bleeding, and nasogastric intubation, rather than cancer or cardiometabolic comorbidities. These findings may improve decision-making and advance care planning for patients with dementia.

Effect of Chorionicity， Gestational Age at Birth and Birth Weight Discordance on Neonatal Outcomes in Twin Pregnancies / 中山大学学报(医学科学版)

ObjectiveTo investigate the effect of chorionicity， gestational age at birth and birth weight discordance on neonatal outcomes in twin pregnancies. MethodsWe conducted a population-based retrospective study of monochorionic diamniotic （MCDA） twin pregnancies and dichorionic diamniotic （DCDA） twin pregnancies who were admitted in the First Affiliated Hospital， Sun Yat-sen University from January 2015 to December 2020. A total of 1504 live-born twins were included， with 386 cases in MCDA group and 1118 cases in DCDA groups， respectively. The comparison of neonatal outcomes between MCDA and DCDA twins was performed using t-test， Wilcoxon rank sum test， Chi-square test or Fisher’s exact test. Logistic regression was performed to evaluate the effects of chorionicity， gestational age at birth， birth weight discordance and sex on neonatal outcomes. There were 168 live-born twins affected by inter-twin birth weight discordance≥25%， with 96 cases in MCDA group and 72 cases in DCDA groups， respectively. Logistic regression was performed to evaluate the effects of chorionicity， gestational age at birth， birth weight light or heavy （small twin or large twin） of the twin and sex on neonatal outcomes. ResultsAmong the 1 504 newborns， gestational age at birth was lower in MCDA group compared with DCDA group （P = 0.000）， and the degree of birth weight discordance was higher in MCDA group than that of the DCDA group （P = 0.001）. Birth asphyxia， respiratory distress syndrome （RDS）， bronchopulmonary dysplasia （BPD）， and sepsis were more frequency in MCDA group compared with DCDA group （P = 0.000， P = 0.000， P = 0.000， P = 0.000）. Low gestational age at birth was an independent risk factor for birth asphyxia， RDS， BPD， sepsis， necrotizing enterocolitis （NEC）≥stageⅡ， acute kidney injury （AKI）， retinopathy of prematurity （ROP）， and neonatal death respectively （P = 0.000， P = 0.000， P = 0.000， P = 0.000， P = 0.011， P = 0.000， P = 0.000， P = 0.000）. High degree of birth weight discordance was an independent risk factor for birth asphyxia， RDS， BPD， sepsis and ROP respectively （P = 0.045， P = 0.000， P = 0.000， P = 0.004， P = 0.017 ）. Chorionicity was not an independent risk factor for neonatal morbidity and death （P > 0.05）. Among the 168 twins with birth weight discordance ≥25%， low gestational age at birth was an independent risk factor for birth asphyxia， RDS， BPD， sepsis and ROP， respectively （P = 0.000， P = 0.000， P = 0.000， P = 0.000， P = 0.000）； small twin was an independent risk factor for birth asphyxia and BPD， respectively （ P = 0.013， P = 0.001）； chorionicity was not an independent risk factor for neonatal morbidity （P > 0.05）. ConclusionChorionicity was not an independent risk factor for adverse neonatal outcome in twin births. Low gestational age at birth and high degree of birth weight discordance were independent risk factor for adverse neonatal outcome in twin births. Small twins had increased risk of adverse neonatal outcome in twins with birth weight discordance ≥25%.

Key elements and checklist of shared decision-making conversation on life-sustaining treatment in emergency: a multispecialty study from China / 世界急诊医学杂志（英文）

@#BACKGROUND: Shared decision-making (SDM) has broad application in emergencies. Most published studies have focused on SDM for a certain disease or expert opinions on future research gaps without revealing the full picture or detailed guidance for clinical practice. This study is to investigate the optimal application of SDM to guide life-sustaining treatment (LST) in emergencies. METHODS: This study was a prospective two-round Delphi consensus-seeking survey among multiple stakeholders at the China Consortium of Elite Teaching Hospitals for Residency Education. Participants were identified based on their expertise in medicine, law, administration, medical education, or patient advocacy. All individual items and questions in the questionnaire were scored using a 5-point Likert scale, with responses ranging from “very unimportant” (a score of 1) to “extremely important” (a score of 5). The percentages of the responses that had scores of 4-5 on the 5-point Likert scale were calculated. A Kendall’s W coefficient was calculated to evaluate the consensus of experts. RESULTS: A two-level framework consisting of 4 domains and 22 items as well as a ready-to-use checklist for the informed consent process for LST was established. An acceptable Kendall’s W coefficient was achieved. CONCLUSION: A consensus-based framework supporting SDM during LST in an emergency department can inform the implementation of guidelines for clinical interventions, research studies, medical education, and policy initiatives.

Changes of choroidal biomarkers in patients with central serous chorioretinopathy / 中华眼底病杂志

Objective:To quantitatively evaluate the changes of choroidal biomarkers in patients with central serous chorioretinopathy (CSC) and preliminarily explore its pathogenesis.Methods:Clinical cross-sectional study. From July 2021 to December 2022, 74 eyes of 65 patients with CSC (CSC group) confirmed by ophthalmic examination at the First Affiliated Hospital of Zhengzhou University were included in the study. Among them, 46 patients (51 eyes) were male, 19 patients (23 eyes) were female. The duration from the onset of symptoms to the time of treatment was less than or equal to 3 months. A control group consisted of 40 healthy volunteers (74 eyes) matched in age and gender. Among them, 26 patients (50 eyes) were male, and 14 patients (24 eyes) were female. Using VG200D from Microimaging (Henan) Technology Co., Ltd., macular scanning source light coherence tomography angiography was performed, with scanning range 6 mm × 6 mm. According to the division of the diabetes retinopathy treatment research group, the choroid within 6 mm of the macular fovea was divided into three concentric circles centered on the macular fovea, namely, the central area with a diameter of 1 mm, the macular area with a diameter of 1-3 mm, and the surrounding area of the fovea with a diameter of 3-6 mm. The device comes with software to record the three-dimensional choroidal vascular index (CVI), choroidal vascular volume (CVV), perfusion area of the choroidal capillary layer (CFA), choroidal thickness (CT), and three-dimensional CVI, CVV, and CT in the upper, temporal, lower, and subnasal quadrants within 6 mm of the fovea. Quantitative data between the two groups were compared using an independent sample t-test. Qualitative data comparison line χ2 inspection. The value of receiver operating curve (ROC) analysis in predicting the occurrence of CSC, including CVI, CVV, CFA, and CT. Results:Compared with the control group, the CVI ( t=3.133, 4.814), CVV ( t=7.504, 9.248), and CT ( t=10.557, 10.760) in the central and macular regions of the affected eyes in the CSC group significantly increased, while the CFA ( t=-8.206, -5.065) significantly decreased, with statistically significant differences ( P<0.05); CVI ( t=7.129), CVV ( t=10.020), and CT ( t=10.488) significantly increased within 6 mm of the central fovea, while CFA ( t=-2.548) significantly decreased, with statistically significant differences ( P<0.05). The CVI ( t=4.980, 4.201, 4.716, 8.491), CVV ( t=9.014, 7.156, 7.719, 10.730), and CT ( t=10.077, 8.700, 8.960, 11.704) in the upper, temporal, lower, and lower nasal quadrants within 6 mm of the central fovea were significantly increased, with statistically significant differences ( P<0.05). In the CSC group, the maximum CVI and CVV were (0.39±0.10)% and (1.09±0.42) mm 3, respectively, on the nasal side of the affected eye. Upper CT was (476.02±100.89) μm. The nasal side CVI, CVV, and CT have the largest changes. The ROC curve analysis results showed that the area under the curve of CT, CVV, and CVI within 6 mm of the central region, macular region, and fovea was over than 0.5. Subcentral CT was the most specific for the diagnosis of CSC. Conclusion:Choroidal biomarkers CVI, CVV, and CT in CSC patients increase, while CFA decreases. Central CT is the most specific for the diagnosis of CSC.

Chronic disease management approaches for fundus disease to be explored and established / 中华眼底病杂志

Chronic disease is a major threat to human health. Fundus disease has become a major ophthalmic disease affecting daily life. Although great breakthroughs have been made in the treatment, compared with other chronic disease management, the management of patients with fundus disease is still in its infancy. To strengthen the management exploration of patients with fundus diseases, establish a management model of fundus diseases and strive to improve patients' awareness of fundus diseases and adherence to treatment and follow-up are the great challenges at present. All ophthalmic centers should strengthen patient education, establish a regional cooperation network, support the construction of grassroots medical capacity, cultivate talents, enhance training, promote the standardized treatment of fundus diseases, standardize fundus imaging inspection and diagnosis, and promote the homogeneous construction of diagnosis and treatment of chronic fundus diseases. We will accelerate the construction of a hierarchical diagnosis and treatment system and the ability to link consultation and referral. Through systematic management and intervention of fundus diseases, a large number of patients with fundus diseases will receive early screening, diagnosis, standardized continuous treatment and systematic management, and improve the quality of life of patients with fundus diseases.

A case of severe fever with thrombocytopenia syndrome with Campylobacter jejuni bacteremia / 中国热带医学

@#Abstract: Objective　 This article aims to present a rare case of severe fever with thrombocytopenia syndrome (SFTS) complicated by with bacteraemia caused by Campylobacter jejuni, and to discuss the pathogenic characteristics, culture methods, clinical features and treatment points of Campylobacter jejuni and the patient's outcome, with a view to raising clinical awareness of blood culture and providing experience for the treatment of this disease. Methods　The clinical data of a case with SFTS complicated by bacteremia caused by Campylobacter jejuni admitted to Weihai Municipal Hospital were collected and the diagnostic process of the pathogenic bacteria as well as the treatment plan were retrospectively analysed. Results　The patient was a female who had been bitten by a tick bite half a month ago and presented to the hospital on 30th August with a fever, vague pain in the peribulbar abdomen and diarrhea for 5 days. Laboratory tests showed leukopenia and thrombocytopenia, and nucleic acid detection for SFTS was positive, resulting in a diagnosis of SFTS. After a week of antiviral treatment with ribavirin and symptomatic treatment, the patient suddenly experienced high fever at night, with a temperature reaching 39.5 °C. Blood cultures were immediately taken from both sides of the double bottle. Bilateral anaerobic bottles were tested for positive after 53.06 hours, and Gram-negative Campylobacter was cultured anaerobically in a transfer blood plate and further identified as Campylobacter jejuni using mass spectrometry MALDI-TOF MS. Vancomycin was stopped clinically on the basis of bacterial pathogenesis and meropenem was used for anti-infection and symptomatic treatment. During the treatment, blood culture and nucleic acid detection for SFTS turned negative, and the patient's symptoms improved. After normal results were achieved in the follow-up testing, the patient was discharged. Conclusions　This case serves as a reminder that Campylobacter jejuni not only causes intestinal infections, but can also lead to extra-intestinal infections in immunocompromised individuals. Clinical and laboratory personnel should increase their recognition of Campylobacter jejuni, prioritize blood culture methods, and utilize a multidisciplinary approach in diagnosis and treatment.

Assessment of risk factors for bronchopulmonary dysplasia with pulmonary hypertension and construction of a prediction nomogram model / 中华儿科杂志

Objective: To explore the risk factors of pulmonary hypertension (PH) in premature infants with bronchopulmonary dysplasia (BPD), and to establish a prediction model for early PH. Methods: This was a retrospective cohort study. Data of 777 BPD preterm infants with the gestational age of <32 weeks were collected from 7 collaborative units of the Su Xinyun Neonatal Perinatal Collaboration Network platform in Jiangsu Province from January 2019 to December 2022. The subjects were randomly divided into a training cohort and a validation cohort at a ratio of 8∶2 by computer, and non-parametric test or χ2 test was used to examine the differences between the two retrospective cohorts. Univariate Logistic regression and multivariate logistic regression analyses were used in the training cohort to screen the risk factors affecting the PH associated with BPD. A nomogram model was constructed based on the severity of BPD and its risk factors,which was internally validated by the Bootstrap method. Finally, the differential, calibration and clinical applicability of the prediction model were evaluated using the training and verification queues. Results: A total of 130 among the 777 preterm infants with BPD had PH, with an incidence of 16.7%, and the gestational age was 28.7 (27.7, 30.0) weeks, including 454 males (58.4%) and 323 females (41.6%). There were 622 preterm infants in the training cohort, including 105 preterm infants in the PH group. A total of 155 patients were enrolled in the verification cohort, including 25 patients in the PH group. Multivariate Logistic regression analysis revealed that low 5 min Apgar score (OR=0.87, 95%CI 0.76-0.99), cesarean section (OR=1.97, 95%CI 1.13-3.43), small for gestational age (OR=9.30, 95%CI 4.30-20.13), hemodynamically significant patent ductus arteriosus (hsPDA) (OR=4.49, 95%CI 2.58-7.80), late-onset sepsis (LOS) (OR=3.52, 95%CI 1.94-6.38), and ventilator-associated pneumonia (VAP) (OR=8.67, 95%CI 3.98-18.91) were all independent risk factors for PH (all P<0.05). The independent risk factors and the severity of BPD were combined to construct a nomogram map model. The area under the receiver operating characteristic (ROC) curve of the nomogram model in the training cohort and the validation cohort were 0.83 (95%CI 0.79-0.88) and 0.87 (95%CI 0.79-0.95), respectively, and the calibration curve was close to the ideal diagonal. Conclusions: Risk of PH with BPD increases in preterm infants with low 5 minute Apgar score, cesarean section, small for gestational age, hamodynamically significant patent ductus arteriosus, late-onset sepsis, and ventilator-associated pneumonia. This nomogram model serves as a useful tool for predicting the risk of PH with BPD in premature infants, which may facilitate individualized early intervention.

Impact of immunosuppression intensified conditioning regimen for patients with strong positive pre-transplantation donor-specific anti-HLA antibodies (DSAs) undergoing haploidentical hematopoietic stem cell transplantation / 中华血液学杂志

Objective: To explore the efficacy of immunosuppression intensified conditioning regimen in patients who have strongly positive donor-specific Anti-HLA antibodies (DSAs) and received a haploidentical hematopoietic stem cell transplantation (haplo-HSCT) . Methods: Clinical data of 10 patients with strongly positive pretransplant DSAs (defined as MFI ≥10000) were retrospectively analyzed in this study. All of them received a haplo-HSCT in the Hematology Department of Shanghai Zhaxin Traditional Chinese & Western Medicine Hospital. Results: ① Of all ten patients, three were males, and seven were females, with a median age of 53.5 (36-64) years. Of the 10 patients, three were diagnosed with acute myeloid leukemia, two were myelodysplastic syndromes (MDS), two were chronic myelomonocytic leukemia (CMML), two were in an accelerated phase of chronic myeloid leukemia (CML-AP), and one was primary myelofibrosis (PMF). ② Conditioning regimen consisted of fludarabine (Flu) /busulfan (Bu) combined with whole-body irradiation (TBI) /cyclophosphamide (Cy). ③ On the seventh day after transplantation, the median pretransplant DSA level was MFI 15 999 (10 210-23 417) and 10 787 (0-22 720). ④ Eight patients acquired hematopoietic reconstitution; the median time of neutrophil engraftment was 14 (10-16) days; and 18 (14-20) days for platelet engraftment. After a median follow-up of 12.5 (1.5-27) months, primary graft failure was found in one patient and another with poor graft function. Seven patients remained in a disease remission state, and all were DSA-negative. Conclusions: An intensified immunosuppression conditioning regimen can efficiently decrease the level of donor-specific anti-HLA antibodies (DSAs), leading to good short-term efficacy.

Effect of multi-glycosides of Tripterygium wilfordii on renal injury in diabetic kidney disease rats through NLRP3/caspase-1/GSDMD pyroptosis pathway / 中国中药杂志

This study investigated the effect of multi-glycosides of Tripterygium wilfordii(GTW) on renal injury in diabetic kidney disease(DKD) rats through Nod-like receptor protein 3(NLRP3)/cysteine-aspartic acid protease-1(caspase-1)/gsdermin D(GSDMD) pyroptosis pathway and the mechanism. To be specific, a total of 40 male SD rats were randomized into the normal group(n=8) and modeling group(n=34). In the modeling group, a high-sugar and high-fat diet and one-time intraperitoneal injection of streptozotocin(STZ) were used to induce DKD in rats. After successful modeling, they were randomly classified into model group, valsartan(Diovan) group, and GTW group. Normal group and model group were given normal saline, and the valsartan group and GTW group received(ig) valsartan and GTW, respectively, for 6 weeks. Blood urea nitrogen(BUN), serum creatinine(Scr), alanine ami-notransferase(ALT), albumin(ALB), and 24 hours urinary total protein(24 h-UTP) were determined by biochemical tests. The pathological changes of renal tissue were observed based on hematoxylin and eosin(HE) staining. Serum levels of interleukin-1β(IL-1β) and interleukin-18(IL-18) were detected by enzyme-linked immunosorbent assay(ELISA). Western blot was used to detect the expression of pyroptosis pathway-related proteins in renal tissue, and RT-PCR to determine the expression of pyroptosis pathway-related genes in renal tissue. Compared with the normal group, the model group showed high levels of BUN, Scr, ALT, and 24 h-UTP and serum levels of IL-1β and IL-18(P<0.01), low level of ALB(P<0.01), severe pathological damage to kidney, and high protein and mRNA levels of NLRP3, caspase-1, and GSDMD in renal tissue(P<0.01). Compared with the model group, valsartan group and GTW group had low levels of BUN, Scr, ALT, and 24 h-UTP and serum levels of IL-1β and IL-18(P<0.01), high level of ALB(P<0.01), alleviation of the pathological damage to the kidney, and low protein and mRNA levels of NLRP3, caspase-1, and GSDMD in renal tissue(P<0.01 or P<0.05). GTW may inhibit pyroptosis by decreasing the expression of NLRP3/caspase-1/GSDMD in renal tissue, thereby relieving the inflammatory response of DKD rats and the pathological injury of kidney.

Whole-course management strategies for gastroesophageal reflux disease: an evidence mapping study based on clinical practice guidelines / 中华胃肠外科杂志

Gastroesophageal reflux disease (GERD) is one of the most common digestive diseases with high incidence, complicated clinical symptoms, difficulties in standard treatment, and heavy medical burden. At present, some GERD-relevant clinical practice guidelines (CPGs) have been issued by different countries and academic organizations, but some recommendations were inconsistent, which has caused some problems for the current clinical whole-course management of GERD. To summarize the relevant evidence among the CPGs on GERD and formulate the whole- course management strategies, we included GERD-relevant CPGs published or updated after 2010 by searching websites of guidelines, relevant professional societies, and electronic databases. We extracted the recommendations and summarized the evidence from the aspects of symptoms, epidemiology, diagnosis and treatment, which was presented in the form of evidence mapping. We included 24 CPGs, including three in Chinese and 21 in English. The clinical practice management strategies of GERD were formulated based on the evidence from the aspects of clinical symptoms, diagnostic methods, medical treatment, anti-reflux surgery and endoscopic treatment, psychological treatment, and traditional Chinese medicine treatment.

Treg Cells, FoxP3 and TGF-β Expression and Significance in Chronic Myeloid Leukemia / 中国实验血液学杂志

OBJECTIVE@#To investigate the expression and significance of regulatory T cells (Tregs), FoxP3 and transforming growth factor-β (TGF-β) in different phase of chronic myeloid leukemia (CML).@*METHODS@#Peripheral blood of 73 CML patients in Department of Hematology, Heze Municipal Hospital from March 2018 to March 2021 were collected. According to patient's period in CML, they were divided into ND CML group (newly diagnosed), CP CML group (chronic period), and BP CML group (blast phase). The percentage of Tregs, expression level of FoxP3 mRNA and TGF-β were detected by flow cytometry, RT-qPCR, and ELISA, respecitively. The roles of above indices in clinical pathogenesis of patients with CML were analyzed.@*RESULTS@#The proportion of Treg in the ND CML group was slightly higher than the CP CML group, but the difference was not statistically significant (P =0.695), while the BP CML group was significantly higher than the other two groups (P =0.008, P <0.001). The expression levels of FoxP3 mRNA in ND CML group, CP CML group and BP CML group were 11.61±2.21, 6.46±1.35 and 8.54±2.13, respectively. Significant difference in FoxP3 mRNA levels was observed among patients in different phases of CML (F =55.199, P <0.001). The expression levels of FoxP3 mRNA both in ND CML group and BP CML group were significantly higher than that in CP CML group (P <0.001), and the ND CML group was the highest (P <0.001). However, the expression levels of TGF-β in different phases of CML showed no statistical differences (H =0.634, P =0.728).@*CONCLUSION@#The abnormal distribution of Treg subset in different phases of CML and the significant increase of the expression level of FoxP3 mRNA in the new onset and blast phase of CML suggest that Tregs may promote the occurrence and progression of CML through immune regulation.

Clinical Efficacy of Compound Tripterygium wilfordii Preparation（Xinfeng Capsules） in Improving Immune Inflammation of Rheumatoid Arthritis Due to Spleen Deficiency and Dampness Exuberance Based on Apriori Algorithm and Random Walk Model / 中国实验方剂学杂志

ObjectiveTo investigate the effect of Xinfeng capsules on immunoinflammatory indicators in patients with rheumatoid arthritis （RA） due to spleen deficiency and dampness exuberance. MethodA total of 102 patients were randomly divided into control group and observation group according to the random number table method， with 51 cases in each group. All patients were treated with methotrexate tablets， while those in the observation group received additional Xinfeng capsules. The course of treatment in both groups was 12 weeks. The 28-joint disease activity score （DAS28）， visual analogue scale （VAS） scores， morning stiffness time， erythrocyte sedimentation rate （ESR）， high-sensitivity C-reactive protein （hs-CRP）， rheumatoid factor （RF）， anti-cyclic citrullinated peptide （anti-CCP） antibody， vascular endothelial growth factor （VEGF）， and serum amyloid A （SAA） of the two groups before and after treatment were compared. The efficacy and incidence of adverse events were compared between the two groups. The Apriori association rule model and random walk model were constructed to evaluate the effect of Xinfeng capsules in improving hs-CRP， ESR， RF， SAA， VEGF， and anti-CCP. ResultThere were no dropouts in this study. There was no statistical difference in the indicators between the two groups before treatment. After 12 weeks of treatment， the total effective rate in the observation group was 90.19% （46/51）， which was higher than 74.51% （38/51） in the control group （χ2＝4.320，P<0.05）. DAS28， VAS score， and morning stiffness time in the observation group were improved compared with those in the control group （P<0.05）. Apriori association rule model results showed that the application of Xinfeng capsules in the observation group had a strong correlation with the reduction of RF， ESR， hs-CRP， SAA， and VEGF. The results of the random walk model showed that the improvement coefficients of hs-CRP， ESR， RF， SAA， and VEGF in the observation group were all better than those of the control group， and the improvement coefficient of anti-CCP in the control group was better than that of the observation group. The improvement degree of hs-CRP， ESR， RF， SAA， and VEGF in the observation group was superior to that of the control group （P<0.05）. The incidence of adverse reactions in the observation group was lower than in the control group （χ2＝4.057，P<0.05）. ConclusionOn the basis of the treatment with methotrexate tablets， Xinfeng capsules can effectively improve the immunoinflammatory level in RA due to spleen deficiency and dampness exuberance and reduce the incidence of adverse reactions.

Relationship between Dining Place, Iodine Source, and Iodine Nutrition in School-Age Children: A Cross-Sectional Study in China / 生物医学与环境科学（英文）

OBJECTIVE@#This study assesses the impact of iodine-rich processed foods and dining places on the iodine nutritional status of children.@*METHODS@#School-aged children (SAC) in seven provinces in China were selected by school-based multi-stage sampling. Urinary iodine, salt iodine, and thyroid volume (TVOL) were determined. Questionnaires were used to investigate dining places and iodine-rich processed foods. The water iodine was from the 2017 national survey. Multi-factor regression analysis was used to find correlations between variables.@*RESULTS@#Children ate 78.7% of their meals at home, 15.1% at school canteens, and 6.1% at other places. The percentage of daily iodine intake from water, iodized salt, iodine-rich processed foods, and cooked food were 1.0%, 79.2%, 1.5%, and 18.4%, respectively. The salt iodine was correlated with the urinary iodine and TVOL, respectively (r = 0.999 and -0.997, P < 0.05). The iodine intake in processed foods was weakly correlated with the TVOL (r = 0.080, P < 0.01). Non-iodized salt used in processed foods or diets when eating out had less effect on children's iodine nutrition status.@*CONCLUSION@#Iodized salt remains the primary source of daily iodine intake of SAC, and processed food has less effect on iodine nutrition. Therefore, for children, iodized salt should be a compulsory supplement in their routine diet.

Impacts of core strength training on balance in martial arts athletes / Impactos do treino de resistência do core sobre o equilíbrio em atletas de artes marciais / Impacto del entrenamiento de la fuerza del core en el equilibrio de los atletas de artes marciales

ABSTRACT Introduction: Physical conditioning is an essential component of sports skills. The main routine training methods for skill enhancement in martial arts players should be based on traditional movements. Core strength training has also been shown to be valid for the physical conditioning of martial arts players. Objective: This paper studies the qualitative changes in the balance of martial arts athletes caused by the insertion of core strength training. Methods: This paper selects 24 martial arts players by sampling and randomly divides them into control and experimental groups. The biomarkers of the volunteers were stored and processed under statistical methods to organize and display the data. Results: The experimental and control groups showed high statistical significance in each index after testing (P<0.05). The results show that the methods used in the experimental and control groups can effectively improve their performance in core and key explosive movements during exercise. There were very significant changes in the extensor muscle peak in both groups. The experimental group showed more significant improvement than the standard group (P<0.05). The experimental group's flexor peaks showed a more significant difference than the control group. In contrast, the experimental group showed a more remarkable improvement than the standard group (P<0.05). Conclusion: Core resistance exercise can effectively promote a center of gravity balance in martial arts athletes. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: O condicionamento físico é um componente essencial das habilidades esportivas. Os principais métodos de treino de rotina para aumento da habilidade dos jogadores de artes marciais devem ser baseados em movimentos tradicionais. O treinamento de resistência do core também já se mostrou válido sobre o condicionamento físico dos jogadores de artes marciais. Objetivo: Este artigo estuda as alterações qualitativas sobre o equilíbrio dos atletas de artes marciais provocadas pela inserção do treino de resistência do core. Métodos: Este artigo seleciona 24 jogadores de artes marciais por amostragem e os divide aleatoriamente em grupos controle e experimental. Os biomarcadores dos voluntários foram armazenados e processados sob métodos estatísticos para organizar e exibir os dados. Resultados: Os grupos experimentais e de controle apresentaram alta significância estatística em cada índice após o teste (P<0,05). Os resultados mostram que os métodos utilizados nos grupos experimentais e de controle podem melhorar efetivamente seu desempenho no core e nos principais movimentos explosivos durante o exercício. Houveram mudanças muito significativas no pico dos músculos extensores em ambos os grupos. O grupo experimental apresentou melhora mais significativa do que o grupo padrão (P<0,05). Em comparação com o grupo controle, os picos de flexores do grupo experimental apresentaram uma diferença mais significativa. Em contrapartida, o grupo experimental apresentou uma melhora mais notável do que o grupo padrão (P<0,05). Conclusão: O exercício de resistência do core pode efetivamente promover a equilíbrio do centro de gravidade nos atletas de artes marciais. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: El acondicionamiento físico es un componente esencial de las habilidades deportivas. Los principales métodos de entrenamiento rutinario para aumentar la capacidad de los jugadores de artes marciales deben basarse en los movimientos tradicionales. El entrenamiento de la fuerza del core también ha demostrado su validez en el acondicionamiento físico de los jugadores de artes marciales. Objetivo: Este trabajo estudia los cambios cualitativos en el equilibrio de los atletas de artes marciales causados por la inserción del entrenamiento de resistencia del core. Métodos: Este artículo selecciona 24 jugadores de artes marciales por muestreo y los divide aleatoriamente en grupos de control y experimental. Los biomarcadores de los voluntarios se almacenaron y procesaron con métodos estadísticos para organizar y mostrar los datos. Resultados: Los grupos experimental y de control mostraron una alta significación estadística en cada índice tras la prueba (P<0,05). Los resultados muestran que los métodos utilizados en los grupos experimental y de control pueden mejorar eficazmente su rendimiento en los movimientos explosivos centrales y principales durante el ejercicio. Hubo cambios muy significativos en el pico muscular extensor en ambos grupos. El grupo experimental mostró una mejora más significativa que el grupo estándar (P<0,05). En comparación con el grupo de control, los picos flexores del grupo experimental mostraron una diferencia más significativa. En cambio, el grupo experimental mostró una mejora más notable que el grupo estándar (P<0,05). Conclusión: El ejercicio de resistencia del core puede promover eficazmente el equilibrio del centro de gravedad en los atletas de artes marciales. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

The value of synthetic MRI in identifying different molecular types of breast cancer and triple negative and non triple negative breast cancer / 中华放射学杂志

Objective:To investigate the value of synthetic MRI quantitative parameters in identifying different molecular types of breast cancer and triple negative breast cancer (TNBC) and non-TNBC.Methods:A retrospective analysis was performed on 208 patients diagnosed with invasive ductal breast cancer in the First Affiliated Hospital of China Medical University from March 2019 to September 2020. All patients underwent synthetic MR examinations and the following quantitative parameters were measured, including tumor diameter, volume, apparent diffusion coefficient (ADC), and corresponding values of T 1, T 2, and proton density (PD). According to the immunohistochemical results, there were 122 cases of progesterone receptor (PR) positive and 86 cases of PR negative, 123 cases of estrogen receptor (ER) positive and 85 cases of ER negative, 79 cases of human epidermal growth factor receptor-2 (HER2) positive and 129 cases of HER2 negative, 149 cases of Ki-67 high expression and 59 cases of Ki-67 low expression; there were 36 cases of TNBC and 172 cases of non-TNBC. Independent samples t test or Mann-Whitney U test were used to compare the quantitative parameters of different molecular types, TNBC and non-TNBC patients. Multivariate logistic regression was used to analyze independent predictors of TNBC, and receiver operating characteristic curve and area under the curve (AUC) were used to evaluate the efficacy of sole and combined parameters in identifying TNBC. Results:T 1 and T 2 values in PR negative breast cancer patients were higher than those in PR positive patients ( t=2.30, Z=2.04, P<0.05); the values of T 1 and T 2 in ER negative patients were higher than those in ER positive patients ( t=2.52, Z=2.48, P<0.05); ADC value and tumor diameter of HER2 positive patients were larger than those in HER2 negative patients ( t=-3.21, Z=-3.22, P<0.05). T 2 value, tumor volume and diameter in patients with Ki-67 high expression were significantly higher than those in patients with Ki-67 low expression ( Z=-3.47, -2.51, -2.84, P<0.05); ADC value in Ki-67 high expression group was less than that in Ki-67 low expression group ( t=3.94, P<0.001). T 1, T 2 values and tumor volume in TNBC patients were higher than those in non-TNBC patients ( t=-3.26, Z=-5.58, Z=-2.02, P<0.05], and ADC value in TNBC patients was lower than that in non-TNBC patients ( t=3.07, P=0.002). Multivariate logistic regression analysis showed that T 2 (OR=1.060, 95%CI 1.028-1.093, P<0.001) and ADC value (OR=0.947, 95%CI 0.911-0.984, P=0.005) were independent predictors of TNBC. The efficacy of each parameter alone and in combination to identify TNBC showed that the T 2 value in the single parameter had the largest AUC (0.759), and there was no significant difference between T 2 value and its combined parameters in the diagnosis of TNBC. Conclusions:The quantitative parameters based on synthetic MRI, especially T 2 value, have value in differentiating different molecular types of breast cancer, TNBC and non-TNBC may be another non-contrast parameter for evaluating tumor aggressiveness beyond ADC value.

Efficacy of immune checkpoint inhibitors and targeted therapy in adjuvant treatment of resectable melanoma: a network meta-analysis / 中华皮肤科杂志

Objective:To assess the efficacy of immune checkpoint inhibitors and targeted therapy in the treatment of resectable melanoma by Bayesian network meta-analysis.Methods:PubMed, Embase and Cochrane databases were searched for randomized controlled trials on adjuvant therapy of resectable melanoma. Based on hazard ratios, a network meta-analysis of relapse-free survival was performed using a Bayesian fixed-effect model to assess therapeutic effect of adjuvant therapy on resectable melanoma. Data were comprehensively analyzed by using StataSE 15 and OpenBUGS 3.2.3 softwares.Results:Six eligible articles involving 5 587 patients assigned to 7 treatment regimens were included. There were 5 019 patients in the stage Ⅲ subgroup, 2 085 in the ulcerated subgroup, 2 629 in the non-ulcerated subgroup, and 2 054 in the BRAF-mutated subgroup; the 7 treatment regimens included surgery + observation or placebo, surgery + adjuvant dabrafenib plus trametinib, surgery + adjuvant nivolumab, surgery + adjuvant ipilimumab, surgery + adjuvant pembrolizumab, surgery + adjuvant bevacizumab, and surgery + adjuvant vemurafenib. In the network meta-analysis, surgery + adjuvant dabrafenib plus trametinib ( HR = 0.47, 95% CI: 0.39 - 0.57) , surgery + adjuvant nivolumab ( HR = 0.49, 95% CI: 0.36 - 0.65) and surgery + adjuvant pembrolizumab ( HR = 0.57, 95% CI: 0.43 - 0.75) were more effective for the improvement of relapse-free survival than surgery alone; the subgroup analysis of stage Ⅲ and ulcerated resectable melanoma showed the same results as the above-mentioned network meta-analysis. In the subgroup analysis of non-ulcerated resectable melanoma, surgery + adjuvant vemurafenib ( HR = 0.48, 95% CI: 0.29 - 0.79) , surgery + adjuvant dabrafenib plus trametinib ( HR = 0.48, 95% CI: 0.33 - 0.70) , and surgery + adjuvant nivolumab ( HR = 0.50, 95% CI: 0.31 - 0.79) could significantly prolong the relapse-free survival compared with surgery alone, but surgery + adjuvant pembrolizumab ( HR = 0.69, 95% CI: 0.45 - 1.06) was not superior to surgery alone. In the subgroup analysis of BRAF-mutated melanoma, surgery + adjuvant bevacizumab ( HR = 0.60, 95% CI: 0.43 - 0.85) , surgery + adjuvant dabrafenib plus trametinib ( HR = 0.47, 95% CI: 0.38 - 0.57) , surgery + adjuvant pembrolizumab ( HR = 0.59, 95% CI: 0.38 - 0.92) and surgery + adjuvant vemurafenib ( HR = 0.65, 95% CI: 0.50 - 0.85) could significantly prolong the relapse-free survival compared with surgery alone. The network meta-analysis was carried out for ranking of these adjuvant treatments, and adjuvant dabrafenib plus trametinib was most likely to rank first in the network meta-analysis and subgroup analysis of stage Ⅲ, ulcerated or BRAF-mutated resectable melanoma, while adjuvant vemurafenib was most likely to rank first in the subgroup analysis of non-ulcerated resectable melanoma. Conclusion:For ulcerated or BRAF-mutated resectable melanoma, dabrafenib plus trametinib may be the optimal adjuvant therapy; for resectable melanoma with unknown BRAF status or wild-type BRAF, nivolumab may be the optimal adjuvant therapy.

Clinical analysis of elderly patients with anti-MDA5 antibody-positive dermatomyositis / 中华老年医学杂志

Objective:To retrospectively analyze the clinical characteristics of elderly patients with anti-MDA5 antibody-positive dermatomyositis.Methods:Data of 62 patients with anti-MDA5 antibody-positive dermatomyositis admitted to Second Xiangya Hospital from May 2016 to December 2019 were collected and patients were divided into an elderly group(≥60 years old, 17 cases)and a non-elderly group(<60 years old, 45 cases). The clinical manifestations, laboratory test resuls, treatment and prognosis of the patients in both groups were statistically analyzed.Results:A total of 62 patients with anti-MDA5 antibody-positive dermatomyositis were included in this study, including 17 elderly patients(27.4%)with an average age of(65.5±5.3)years and 45 non-elderly patients(72.6%)with an average age of(46.5±8.4)years.Compared with non-elderly patients, older patients had a shorter disease duration[(1.6±1.0)months vs.(3.7±3.3)months, t=3.883, P<0.001], a higher proportion of patients with exertional dyspnea(15/17 or 88.2% vs.26/45 or 57.8%, χ2=5.11, P=0.024)and with combined positive anti-Ro-52 antibodies(15/17 or 88.2% vs.26/45 or 57.8%, χ2=5.11, P=0.024), and a higher mortality rate[(12/17 or 70.6%) vs.(8/45 or 17.8%, χ2=15.748, P<0.001)]. In contrast, fewer elderly patients than non-elderly patients had the Heliotrope's sign(9/17 or 41.2% vs.38/45 or 57.8%), χ2=5.07, P=0.024). Conclusions:Elderly patients with anti-MDA5 antibody-positive dermatomyositis have a unique clinical phenotype with an acute onset, atypical rashes, severe pulmonary lesions, making treatment difficult, and have a poor prognosis.

Quality evaluation of registration data of Shenzhen Type 1 Diabetes Alliance: based on the collaborative research platform network of China Type 1 Diabetes Alliance / 中国医师杂志

Objective:To evaluate the data quality of Shenzhen Type 1 Diabetes Alliance (SZT1D), and to provide a basis for evaluation and improvement for the continuous improvement of data quality.Methods:From December 2018 to July 2021, 697 first-visit type 1 diabetes (T1DM) patients (including 501 in Shenzhen and 196 out-of-Shenzhen) and 120 re-visited T1DM patients (including 113 in Shenzhen and 7 out-of-Shenzhen) who were registered by SZT1D in collaborative research platform network of China Type 1 Diabetes Alliance (hereinafter referred to as China T1D). The data quality was evaluated from three dimensions: data completion, accuracy and revisit. The data completion degree was evaluated by the overall data completion degree and the key indicator completion degree; the data accuracy was evaluated by the probability of abnormal blood glucose value; the patient′s return visit was evaluated by the return visit rate.Results:The main characteristics of T1DM in SZT1D were young and middle-aged adults [age: (34.4±17.1)years] with thin body [BMI: (19.80±3.52)kg/m 2)], half of male and female patients [proportion of male: 52.4%(365/697)]; the main types of diagnosis were classical T1DM [65.22%(150/230)] and latent autoimmune diabetes in adults(LADA) [26.08%(60/230)], and the fasting blood glucose (FPG) [(10.93±6.98)mmol/L] and glycosylated hemoglobin (HbA 1c) [(10.63±3.01)%] were high. The average completion rate of the overall data of the first diagnosed patients in SZT1D was only 60% [(62.9±31.5)%]: the number of patients with overall data completion ≥80% in SZT1D was only 50.2%(350/697); the number of patients with overall data completion ≥80% in Shenzhen was less than that outside Shenzhen [44.3%(222/501) vs 65.3%(128/196), P<0.001]. The key indicators with better completion rate of first-visit were disease course [76.2%(531/697)], age of onset [75.8%(528/697)], family history of diabetes [74.9%(522/697)], etc., but none of them had a completion rate of more than 80%, and the diabetes self-management behavior assessment questionnaire and scale score were completely missing; the frequency of daily blood glucose monitoring [46.1%(231/501) vs 64.3%(126/196), P<0.001], current insulin regimen [44.3%(222/501) vs 63.3%(124/196), P<0.001], number of diabetic ketoacidosis (DKA) since the onset of the disease [45.7%(229/501) vs 64.8%(127/196), P<0.001] and the number of symptomatic hypoglycemia in the past 1 month [39.3%(197/501) vs 63.8%(125/196), P<0.001] were higher in Shenzhen than those reported outside Shenzhen. In addition, the probability of abnormal FPG and postprandial glucose (PPG) [5.2%(24/466); 3.8%(19/236)] were low. The revisit rate was not high [17.2%(120/697)], and the revisit rate in Shenzhen was higher than that outside Shenzhen [22.6%(113/501) vs 3.6%(7/196), P<0.001]. The first revisit rate was 16.2%(113/697) and the second revisit rate was seriously insufficient [1.0%(7/697)]. Conclusions:The data quality of T1DM patients recorded by SZT1D needs to be further improved. Improving the information interconnection between China-T1D and SZT1D, employing quality control personnel and building a systematic data quality evaluation analysis and feedback mechanism are methods to promote the comprehensive, accurate and efficient input of T1DM data and continuously improve the evaluation methods to improve the overall data quality.

Analysis of dietary quality of preschool left behind children by using the revised Chinese diet balance index / 中国学校卫生

Objective@#To evaluate the dietary quality by adjusted diet balance index (DBI_16) of preschool left behind children in Anhui Province, and to provide a reference for rapidly and accurately evaluating their nutrition condition.@*Methods@#During September to December of 2018, selected 306 left behind children and 598 non left behind children aged 3-6 years old of Anhui Province in total. Four scoring methods (TS total score, LBS Low Bound Score, HBS High Bound Score, DQD Diet Quality Distance) were used to evaluate the dietary quality by Diet Balance Index Revision (DBI_16), and scores were compared to reflect the diet quality of preschool children in LBC group and NLBC group.@*Results@#The score of TS (-18.2, -16.1) in LBC group was lower than that of NLBC group, the scores of LBS(24.8, 23.1), HBS (7.9, 6.4) and DQD (35.9, 34.4) in LBC group were higher than that of NLBC group( Z =-46.02, 12.45, 4.14, 4.78, P <0.05). The daily intake of vegetables, fruits, animal food, milk, soybean and drinking water were obviously under the RNI, the dietary intake scores of milk(-4.1, -2.7), animal food (-2.2, -0.8) and food species (-7.4, -6.2) in LBC group were higher than that in NLBC group( Z =-26.42, 13.51, -6.59, P <0.01). About 44.1% of the preschool LBC were in moderate or severe deficit of food intake, 66.0% of the LBC were in the higher level of dietary imbalance, the LBC group s excessive and imbalance problem were of significant differences than those in the NLBC group ( χ 2=15.79, 11.51, P <0.05).@*Conclusion@#The dietary quality of preschool children in Anhui Province should be improved, the main diet problem was the dietary imbalance, which was related to deficiency in nutrients intake. The scores of DBI_16 in LBC group were significant different with those in NLBC group, it is necessary to take specific intervention to increase the intake of milk, eggs and fruits among preschool children.