Current research on driving fatigue induced by special vehicles / 军事医学

Fatigue-related traffic accidents and fatalities have been extensively studied by scholars globally.Specialized vehicles,due to their unique mission profiles,are more likely to cause driving-related fatigue and serious consequences.This paper reviews the current research of fatigue driving by using an inductive analysis method to summarize the mechanisms,risk factors,and monitoring methods.This paper also offers a vision of priorities and methodologies for research in the future.It is recommended that the mechanisms of driving fatigue be explored at the molecular biological level and that fatigue monitoring systems be made more feasible via the combined application of non-intrusive monitoring in order to reduce the toll on life and property taken by driving fatigue.

Expert consensus on the bi-directional screening for Mycobacterium tuberculosis and human immunodeficiency virus / 上海预防医学

Tuberculosis （TB） and human immunodeficiency virus infection / acquired immune deficiency syndrome （HIV/AIDS） are both serious global public health threats. Early detection of infected persons and/or patients through TB/HIV bi-directional screening is crucial for prevention and control strategy in China and globally. In recent years， with the promotion and application of new TB and HIV detection technologies worldwide， TB/HIV bi-directional screening technologies and strategies have made remarkable changes. This expert consensus introduces the significance and challenges of TB/HIV bi-directional screening， summarizes important progress of research and applications， and makes recommendations on screening measures and procedures to further strengthen TB/HIV bi-directional screening in China.

Quality Evaluation Status of Traditional Chinese Medicine Knowledge Bases and the Construction of Evaluation Indexes / 中医杂志

From the perspectives of traditional Chinese medicine （TCM） information knowledge base and assisted decision-making knowledge base， the construction status， quality evaluation status and existing problems of current TCM knowledge bases have been sorted out. And based on the quality evaluation strategies and dimensions of know-ledge bases in other disciplines， the evaluation indexes for TCM knowledge base is discussed， and the evaluation framework is initially formed， providing ideas for the improvement of the TCM knowledge base evaluation system. In terms of the evaluation indexes， there are basic evaluation dimensions which include data sources， data collection， and data application. The specific evaluation dimension of the information-based knowledge base is data quality， while that of the assisted decision-making knowledge base is data matching. Except for the data application dimension which counts the valid data items in the database for calculation， other indexes are scored based on the qualitative evaluation of "yes"， "no" or "unknown". The basic evaluation score and the specific evaluation score are added to obtain the total score. The knowledge base is graded according to the score， and the results are presented in the form of grade plus number.

Clinical efficacy of tirellizumab combined with chemotherapy in the treatment of advanced non-small cell lung cancer / 中国基层医药

Objective:To investigate the efficacy of tirellizumab combined with chemotherapy in the treatment of advanced non-small cell lung cancer and its effect on immune function and quality of life in patients.Methods:In this retrospective case-control study, we analyzed the clinical data of 104 patients with advanced (stages III and IV) non-small cell lung cancer who received treatment at Zhoushan Hospital between May 2021 and June 2022. These patients were divided into two groups: group A ( n = 52) and group B ( n = 52), based on the treatment methods utilized. Patients in group A received chemotherapy with gemcitabine plus cisplatin or pemetrexed plus cisplatin. Meanwhile, patients in group B were treated with tirellizumab combined with chemotherapy regimens of gemcitabine plus cisplatin or pemetrexed plus cisplatin, with 21 days as a treatment cycle. Both groups of patients received three cycles of treatment. The short-term efficacy was compared between the two groups. Additionally, serum levels of tumor markers, immune function indexes, quality of life score, and incidence of adverse reactions were compared between the two groups before and after treatment. Results:The short-term response rate in group B was significantly higher than that in group A [51.92% (27/52) vs. 32.69% (17/52), Z = 4.11, P < 0.001]. When compared with pretreatment levels, serum levels of tumor markers and the percentage of CD8 + cells decreased in both groups after treatment. Notably, the serum levels of tumor markers and the percentage of CD8 + cells were significantly lower in group B compared with group A (all P < 0.05). Moreover, after treatment, the percentage of CD4 + cells, the ratio of CD4 +/CD8 + cells, functional subscale, symptom subscale, and total score increased significantly compared with pretreatment levels (all P < 0.05) and were significantly higher in group B compared with those in group A (all P < 0.05). The incidence of adverse events in group B was significantly higher than that in group A [44.23% (23/52) vs. 21.15% (11/52), χ2 = 6.29, P = 0.012]. Conclusion:Tirelizumab combined with chemotherapy is effective for advanced non-small-cell lung cancer. The combined therapy can lower serum levels of tumor markers, restore immune function, and improve overall quality of life.

Minimally invasive treatment of acromioclavicular joint dislocation with Tight Rope by modified technique bare-handed / 中国运动医学杂志

Objective To explore the method and the clinical effect of minimally invasive treating ac-romioclavicular joint dislocation by modified technique bare-handed Tight Rope.Methods A retrospec-tive analysis was performed on 61 cases of acromioclavicular joint dislocation(35 males and 26 fe-males,aged 45.6±5.2 years),treated with minimally invasive internal fixation by modified technique bare-handed Tight Rope between June 2018 and November 2021 in our hospital.According to Tossy classification,21 of them were Tossy Ⅱ and 40 were Tossy Ⅲ.The clinical effect was evaluated by Karlsson criteria,and the shoulder function was assessed by using the Oxford shoulder joint and Con-stant-Murley scores.Results All patients were followed up 9～12 months(11.2 months on the average).Sixty of them were restored without re-dislocation,reaching 60 of excellence and an excellence rate of 98.36％.At the last follow-up,the Constant-Murley and Oxford shoulder joint scores were 95.65±2.32 and 12.92±0.81,both significantly better than before surgery(P<0.01),with the satisfaction rate of 96.74％.Conclusion The treatment of acromioclavicular joint dislocation with modified technique bare-handed Tight Rope is minimally invasive,stable,not easy to relocate,and friendly to acromiocla-vicular joint and subacromial structure.Moreover,the shoulder joint function is well-recovered after the surgery with satisfactory effect.

Impact of 24 h movement behaviors on fundamental motor skills in preschool children / 中国学校卫生

Objective@#To investigate the association between 24 h movement behaviors (physical activity, sleep, and screen time) and fundamental motor skills (FMS) in preschool children, in order to provide the reference and basis for ensuring the longterm development of childrens motor skills.@*Methods@#A total of 607 children aged 3 to 5 years old were selected from 6 kindergartens of 6 urban districts in Taiyuan in March 2022, through a combination of convenient sampling and stratified cluster random sampling method, and the baseline test was conducted to collect data on the childrens 24 h movement behaviors and FMS; the followup test after one year was carried out in March 2023 to collect FMS data. The test of gross motor development-3rd was used to assess the childrens FMS levels. Physical activity and sleep duration were measured using ActiGraph GT3X+ accelerometers, while screen time was reported by parents. Pearson correlation analysis, hierarchial and binary Logistic regression analyses were used to analyze the association of 24 h movement behavior with FMS.@*Results@#The results of baseline showed that total of physical activity (TPA) at baseline was positively associated with manipulation skills, mobility skills and total score of TGMD-3 (β=0.40, 3.87, 4.27, P<0.01). The followup results after one year indicated that lowintensity physical activity (LPA) and screen time at baseline were negatively associated with increased TGMD-3 scores one year later (β=-1.93, -0.79, P<0.01). Conversely, baseline moderatetovigorousintensity physical activity (MVPA), TPA and sleep duration were positively associated with increased TGMD-3 scores after one year (β=4.62, 4.51, 3.19, P<0.01). The followup results showed that meeting 2 or 3 items of the 24 h movement behavior guidelines was significantly associated with an increased likelihood of achieving motor skill proficiency (OR=2.31, 3.32, P<0.01) compared to not meeting any 24 h movement behavior guideline after one year.@*Conclusions@#MVPA and enough sleep could positively affect FMS improvement, whereas LPA and long screen time could negatively affect FMS improvement at one year followup. Schools and families should ensure that preschool children meet the recommended standards of the 24 h movement behavioral guidelines to promote longterm development of FMS.

An outbreak of school influenza complicated with mycoplasma pneumoniae infection / 中国学校卫生

Objective@#To describe the clinical features, causal agent and transmission mode of a fever outbreak in a school in Shanghai.@*Methods@#Field epidemiological approaches including case definition development, searching for contacts, distribution of diseases description, environmental sampling and laboratory testing.@*Results@#A total of 16 influenza like cases were included, all concentrated in the one class of grade two, including 15 students and 1 teacher. Among student cases, the incidence rate was 36.59% (15/41), the average age was 7.4 years, the incidence rate was 36.84%(7/19) for boys, 36.36%(8/22) for girls. The clinical course was 5-15 days, with the median of 9 days, and 18.75%(3/16) of the cases stayed studying while sick. The nasopharyngeal swab specimens in 16 cases all tested positive for influenza B, of which 11 tested positive for mycoplasma pneumoniae and 1 case also tested positive for coronavirus OC43. Body temperature, number of mononuclear cells, and treatment time of patients infected with Influenza B and mycoplasma pneumoniae were higher than those of patients infected with influenza B alone( P <0.05). The outbreak lasted for 12 days, all sick students were treated and discharged from hospital, with no severe cases or death, and the outbreak was effectively controlled.@*Conclusion@#This campus cluster outbreak caused by influenza B and mycoplasma pneumoniae. Patients with influenza B with mycoplasma pneumoniae have severe symptoms and a long course of illness, suggesting the importance of early management of the epidemic.

Progress on three-dimensional cell culture technology and their application / 生物医学工程学杂志

Three-dimensional (3D) cell culture model is a system that co-culture carriers with 3D structural materials and different types of cells in vitro to simulate the microenvironment in vivo. This novel cell culture model has been proved to be close to the natural system in vivo. In the process of cell attachment, migration, mitosis and apoptosis, it could produce biological reactions different from that of monolayer cell culture. Therefore, it can be used as an ideal model to evaluate the dynamic pharmacological effects of active substances and the metastasis process of cancer cells. This paper compared and analyzed the different characteristics of cell growth and development under two-dimensional (2D) and 3D model culture and introduced the establishment method of 3D cell model. The application progress of 3D cell culture technology in tumor model and intestinal absorption model was summarized. Finally, the application prospect of 3D cell model in the evaluation and screening of active substance was revealed. This review is expected to provide reference for the development and application of new 3D cell culture models.

Application of metagenomic next-generation sequencing in Streptococcus suis infection: a case report / 中华检验医学杂志

A case of Streptococcus suis sepsis and streptococcal toxic shock syndrome diagnosed by metagenomic next-generation sequencing (mNGS) was presented. A 50-year old male patient visited Zengcheng Branch of Nanfang Hospital on June 25th, 2021. The patient developed fever, dizziness and shock with typical epidemiological history. mNGS revealed Streptococcus suis in blood sample. The diagnosis of Streptococcus suis sepsis and streptococcal toxic shock syndrome were made. Meropenem was given as empirical antibiotics. Antibiotics were adjusted to meropenem and clindamycin while Streptococcus suis was detecting by mNGS and downgraded to piperacillin/tazobactam and clindamycin when symptoms improved. The diagnosis was then confirmed by blood culture. The patient developed dry gangrene and sudden deafness in the later stage and was discharged after treatment. Compared with traditional diagnostic techniques, mNGS has advantages such as timeliness and accuracy, and plays a key role in the field of severe infections and rare pathogen infections. It is suggested that combining mNGS and traditional diagnostic techniques have the advantages for early diagnosis and early treatment.

Efficacy of combined double composite tissue Z-plasty with nasolabial anatomical reconstruction on nasal deformity in secondary unilateral cleft lip / 中华医学美学美容杂志

Objective:To investigate the repair of the severe nasal deformity in the unilateral cleft lip secondary with the methods in the composite tissue Z-plasty and the nasolabial anatomical reconstruction.Methods:A total of 25 patients with severe nasal deformity due to secondary unilateral cleft lip underwent the reconstructive surgery using the technique of composite tissue Z-plasty and the nasolabial anatomical reconstruction for anatomical restoration of cartilage, muscle, and soft tissue layers. All patients were followed up for 3-24 months, with an average period of 7.6 months. The treatment outcomes were evaluated by a questionnaire in postoperative follow-up.Results:All the 25 patients had achieved satisfactory nostril shape and no other complications such as bleeding, infection and flap necrosis were recorded. A total of 25 patients were evaluated postoperatively. The average columella length was significantly improved from an average of 14.2 mm preoperatively to 20.2 mm postoperatively. The average ratio of the cleft side columella height to the alar base width was 0.18 preoperatively and 0.30 postoperatively. The postoperative basal and frontal views revealed a better shape of the nostrils, columella and nasal floor. GAIS questionnaires of 25 patients demonstrated that 20 patients reported great improvement, 4 patients reported moderate improvement, 1 patient had poor improvement in size and shape of the affected side nostril who undevwent the another repair of the rdure in 12 months postoperation. The ectopic muscles around the pear hole was completely released and the effect was good after repair. The satisfactory rate was 96%.Conclusions:Combining the composite tissue Z-plasty with the nasolabial anatomical reconstruction allows for thorough anatomical restoration of cartilage, muscle, and skin layers in unilateral cleftlip nasal deformities. This single-step approach is a safe and technically easy therapeutic option that is associated with high patients′ satisfaction. This method should be considered for promotion in clinic.

Relationship between red blood cell distribution width and short-term mortality of hip fractures in the elderly / 中华老年医学杂志

Objective:To study the relationship between red blood cell distribution width(RDW)and short-term mortality in elderly patients with hip fragility fractures.Methods:The clinical data and blood routine test at admission of 205 elderly patients with brittle hip fractures who were admitted to our hospital from 2020 to 2021 and were followed up for one year were retrospectively analyzed.The comorbid conditions, RDW and cumulative mortality at 6 months and 1 year after fractures were counted, and the relationship between RDW and short-term mortality were analyzed.Results:The 6-month(6.7% and 20.8%, χ2=8.591, P=0.003)and 1-year(6.7% and 26.7%, χ2=14.818, P<0.001)mortality of patients with ≤1 comorbidity were significantly lower than those of patients with ≥2 comorbidities.Moreover, the 6-month and 1-year mortality in patients with RDW>13.5% were significantly higher than those of patients with RDW ≤ 13.5%.The proportion of RDW>13.5 % in patients with at least two comorbidities was significantly higher than that in patients with ≤1 comorbidity.Taking RDW=13.6% as the cut-off value of 6-month and 1-year mortality, the sensitivity and specificity for predicting 6-month mortality were 71.4 % and 59.9 %, respectively, and the sensitivity and specificity for predicting 1-year mortality were 64.7 % and 59.6 %, respectively. Conclusions:Red cell distribution width is associated with short-term mortality, and higher RDW is associated with a higher risk of mortality among elderly patients with brittle hip fractures.

Enteral nutrition support for lysinuric protein intolerance: a case report / 中华临床营养杂志

Lysinuric protein intolerance (LPI) is an autosomal recessive disorder caused by defective plasma membrane transport of cationic amino acids (lysine, arginine, and ornithine). LPI is characterized by recurrent vomiting and diarrhea, coma following intake of protein-rich foods, and aversion to high-protein foods, further leading to malnutrition and even death. Some children with LPI also develop alveolar proteinosis. Nutrition support is an important part of treatment. Here we report a case of a 4-year-old girl with LPI, alveolar proteinosis, systemic lupus erythematosus, and cellular immune dysfunction, where nutrition support successfully improved her nutritional status. The relevant literatures are reviewed to provide guidance on the nutritional diagnosis and treatment of LPI.

Effect of maxillary expansion combined with orofacial myofunctional therapy on the position of the tongue of children with mouth breathing / 临床耳鼻咽喉头颈外科杂志

Objective:This study aimed to investigate the change of the position of the tongue before and after combined treatment of maxillary expansion and orofacial myofunctional therapy in children with mouth-breathing and skeletal class Ⅱmalocclusion. Methods:A total of 30 children with skeletal class Ⅱ malocclusion and unobstructed upper airway were selected. The 30 children were divided into mouth-breathing group（n=15） and nasal-breathing group（n=15） and CBCT was taken. The images were measured by Invivo5 software. The measurement results of the tongue position of the two groups were analyzed by independent samples t-test. 15 mouth-breathing children with skeletal class Ⅱ malocclusion were selected for maxillary expansion and orofacial myofunctional therapy. CBCT was taken before and after treatment, the measurements were analyzed by paired sample t test with SPSS 27.0 software package. Results:The measurement of the tongue position of the mouth-breathing and nasal-breathing groups were compared, the differences were statistically significant（P<0.05）. The measurement of the tongue position showed significant difference after the combined treatment of maxillary expansion and orofacial myofunctional therapy in children with mouth-breathing and skeletal class Ⅱmalocclusion（P<0.05）. Conclusion:Skeletal class Ⅱ malocclusion children with mouth-breathing have low tongue posture. The combined treatment of maxillary expansion and orofacial myofunctional therapy can change the position of the tongue.

Efficacy comparison of robot-assisted percutaneous screw implantation and free-hand open screw implantation by Wiltse approach in the treatment of thoracolumbar fracture / 中华创伤杂志

Objective:To compare the clinical efficacy of robot-assisted percutaneous screw implantation and free-hand open screw implantation by Wiltse approach in the treatment of thoracolumbar fracture.Methods:A retrospective cohort study was performed to analyze the clinical data of 71 patients with thoracolumbar fracture admitted to Second Affiliated Hospital of Soochow University from May 2018 to May 2020. There were 52 males and 19 females, with age range of 22-54 years［(41.0±7.8)years］. Of all, 33 patients were treated with robot-assisted percutaneous screw implantation (Group A) and 38 patients were treated with free-hand open screw implantation by Wiltse approach (Group B). Following parameters were measured, including frequency of radiation exposure, operation time, intraoperative blood loss, length of hospital stay, incidence of complications, rate of fracture healing at 3 months and 6 months postoperatively, visual analogue scale (VAS) and Oswestry dysfunction index (ODI) at 3 days, 3 months, 6 months postoperatively and at the last follow-up, anterior vertebral body height ratio and sagittal Cobb angle preoperatively, at 3 days postoperatively and at the last follow-up, and rate of screw implantation of grade A and B and rate of facet joint violation at 3 days postoperatively.Results:All patients were followed up for 10-24 months［(15.2±4.4)months］. Frequency of radiation exposure and operation time showed no statistical differences between the two groups (both P>0.05). Intraoperative blood loss was 100(100, 135)ml in Group A, less than 160(120, 200)ml in Group B ( P<0.01). Length of hospital stay was 8(7, 11) days in Group A, shorter than 12(10, 16)days in Group B ( P<0.01). There were no complications such as infection, spinal nerve injury or cerebrospinal fluid leakage in both group. There were no significant differences between the two groups in the rate of fracture healing at 3 and 6 months postoperatively (all P>0.05). VAS and ODI in Group A was 3(2, 4)points and 21(18, 23)points at 3 days postoperatively, lower than 4 (3, 5)points and 27(20, 32)points in Group B ( P<0.05 or 0.01), and the two groups showed no significant differences in VAS and ODI at other time points (all P>0.05). There were no significant difference in the anterior vertebral body height ratio or sagittal Cobb angle between the two groups at 3 days postoperatively and at the last follow-up (all P>0.05). Rate of screw implantation of grade A and B was 96.5% (191/198) in Group A, higher than 90.4% (206/228) in Group B ( P<0.05). Rate of facet joint violation was 4.0%(8/198) in Group A, lower than 11.8% (27/228) in Group B ( P<0.01). Conclusion:For thoracolumbar fracture, robot-assisted percutaneous screw implantation is superior to free-hand open screw implantation by Wiltse approach in terms of less bleeding, shorter hospitalization, earlier pain alleviation, higher accuracy of screw implantation and lower risk of facet joint violation.

Clinical and cardiac MR characteristics of heart involvement in patients with Fabry disease / 中华放射学杂志

Objective:To investigate the clinical and cardiac magnetic resonance (CMR) characteristics of heart involvement in patients with Fabry disease (AFD).Methods:From January 2018 to March 2021, eight AFD patients [3 males and 5 females, mean age (50±11) years old, range 26-60 years old] confirmed by genetic testing or pathology in Fuwai Hospital were retrospectively included in this study. At the same time, sixteen patients with hypertrophic cardiomyopathy (HCM) [6 males and 10 females, mean age (46±15) years old] and 16 healthy individuals [6 males and 10 females, mean age (51±11) years old] were included as controls. The clinical baseline data and CMR data of the patients were collected and analyzed. The CMR data were analyzed using the software CVI42, with the corresponding parameters automatically generated. One-way ANOVA or Kruskal-Wallis test was used to compare the differences in the parameters among the three groups. Independent-samples t test, Fisher precise test or Mann-Whitney U test were used for the comparison between each two groups. Results:Statistically significant difference was found in renal insufficiency between the HCM group and the AFD group; No other significant difference was found in other clinical factors and ECG results (all P>0.05). CMR results showed that in the AFD group, there were 5 cases with symmetric or roughly symmetric hypertrophy, and 3 with asymmetric hypertrophy. The late gadolinium enhancement (LGE) showed myocardial enhancement in 5 patients, mainly presenting as multiple intermural enhancement, and partially as local subendocardial enhancement. In the HCM group, fourteen cases suffered mainly asymmetric ventricular septal thickening, with or without thickening of other parts of left ventricular wall; and 2 cases had thickening of middle and distal part of the left ventricle. The LGE showed myocardial enhancement in 14 patients, which manifested as focal or patchy enhancement in hypertrophic myocardium, including focal enhancement in the right ventricular insertion of ventricular septum (more common) and subendocardial enhancement in the middle and far segments of left ventricle. Statistically significant difference was found in the differences between the left atrial anterior posterior diameter, the maximum wall thickness of left ventricular, the left ventricular myocardial mass index (LVMI) and the native T 1 value among the three groups (all P<0.001). However, there was no statistically significant difference in the left atrial anterior posterior diameter and the maximum wall thickness of left ventricular between AFD group and HCM group ( P>0.05). The LVMI in AFD group was higher than that in healthy group and HCM group (all P<0.05). Significant difference was found in the native T 1 value among the three groups, with the native T 1 value of the AFD group [(1 177.4±46.0) ms] was significantly lower than that of the healthy group [(1 244.5±34.3) ms] and the HCM group [(1 278.8±41.6) ms], with ( F=13.10, P<0.001). Conclusions:The clinical characteristics of AFD and HCM are quite similar. When AFD is suspected, CMR imaging should be the first choice for imaging examination. Especially, T 1 mapping imaging can provide important information for the diagnosis of AFD.

Isolation and Identification of Arisaema Cum Bile Fermentation Strain and Preliminary Investigation on Its Compound Strain Fermentation / 中国实验方剂学杂志

ObjectiveIn order to solve the problem that the quality and stability of Arisaema Cum Bile in the fermentation process with hybrid bacteria were not easy to control， the microorganism in the fermentation process of Arisaema Cum Bile was isolated and identified， the dominant strains were screened and the fermentation process of Arisaema Cum Bile with compound bacteria was investigated. MethodThe submerged culture during the fermentation process of Arisaema Cum Bile was taken out for strain separation and purification. Bacteria and fungi multiphase identification and detection methods and automatic microbial analysis system were used to analyze and compare DNA sequences and identify microorganisms. The isolated and identified strains were respectively inoculated and fermented. After screening the dominant strains， a preliminary exploration of compound strain fermentation were carried out. The contents of index components in Arisaema Cum Bile fermented by compound strain and traditional Arisaema Cum Bile were compared by ultra-performance liquid chromatography-triple quadrupole tandem mass spectrometry （UPLC-QqQ-MS/MS）. Mmobile phase was 0.1% formic acid acetonitrile solution （A）-0.1% formic acid aqueous solution （B） for gradient elution （0-2 min， 35%-45%A； 2-10 min， 45%-48%A； 10-12 min， 48%-100%A； 12-12.01 min， 100%-35%A； 12.01-15 min， 35%-65%A）， the flow rate was set at 0.35 mL·min-1. The mass spectrographic analysis employed electrospray ionization （ESI）， negative ion acquisition mode and multiple reaction monitoring （MRM） scanning mode were adopted to collect information， the collection range was m/z 50-1 000. ResultEight microorganisms were isolated and identified from the submerged culture of Arisaema Cum Bile. Among them， Enterococcus sp. （anaerobic） and E. casseliflavus were selected as the dominant strains in the fermentation process. Compared with the traditional fermentation method， the contents of chenodeoxycholic acid， hyodeoxycholic acid and hyocholic acid in free cholic acid increased by 1.76， 0.06， 0.19 mg·g-1， respectively. In bound cholic acid， glycochenodeoxycholic acid， taurochenodeoxycholic acid， glycohyodeoxycholic acid， taurohyodeoxycholic acid， glycohyocholic acid， taurine porcine cholic acid decreased by 0.63， 0.23， 0.26， 0.16， 0.03， 0.04 mg·g-1， respectively. ConclusionArisaema Cum Bile with compound strain fermentation （Enterococcus sp. and E. casseliflavus） can be fermented more completely， the fermentation cycle can be shortened， and the quality and stability of products can be improved.

Predictors of poor short-term outcome in patients with autoimmune encephalitis / 中华检验医学杂志

Objective:To analyze the risk factors of poor short-term outcome in patients with autoimmune encephalitis (AE).Methods:The data were collected retrospectively from patients hospitalized in the First Affiliated Hospital of Fujian Medical University from March 2016 to January 2021. According to the Modified Rankin Scale (mRS), eighty-one patients with AE were divided into the good prognosis group (mRS≤2, n=48) and the poor prognosis group (mRS>2, n=33). The clinical data, including the basic demographic data, main clinical manifestations, cranial MRI and electroencephalogram, as well as laboratory indicators from blood and cerebrospinal fluid (CSF), were compared between two groups, and the risk factors for poor outcome were analyzed by multivariate logistic regression. The receiver operating characteristic (ROC) curve was used to determine the cut-off value of these risk factors on predicting the poor short-term outcome for the AE patients. Results:The time of hospitalization was significantly longer in the poor prognosis group than in the good prognosis group ( P<0.05). Prevalence of severe disease course at admission, abnormal mental and behavior, δ wave and δ brush of abnormal EEG was significantly higher in the poor prognosis group than in the good prognosis group (all P<0.05). Serum leukocyte count, neutrophil count, lymphocyte count, mononuclear cell count, C-reactive protein, procalcitonin(PCT), alanine aminotransferase, aspartate transaminase, lactate dehydrogenase, creatine kinase, creatine kinase isoenzyme, apoA1/B, calcium, sodium, anion gap in serum, CSF oligoclonal bands, CSF-IgG index and antibody titer were significantly different between the two groups (all P<0.05). Severity of illness at admission ( OR=1.816, 95% CI 1.250-2.639, P=0.002), PCT ( OR=1.345, 95% CI 1.008-1.794, P=0.044), antibody titer in serum ( OR=1.422, 95% CI 1.071-1.888, P=0.015), CSF-IgG index ( OR=1.802, 95% CI 1.035-3.138, P=0.037) and anionic gap ( OR=1.640, 95% CI 1.191-2.259, P=0.002) were the independent risk factors for the poor short-term prognosis of patients with AE. The AUC value of combing the above 5 indexes to predict the poor short-term prognosis in patients with AE was 0.920 (95% CI 0.834-0.971), with 83.87% sensitivity and 88.37% specificity. Conclusion:Severity of illness at admission, PCT, antibody titer in serum, CSF-IgG index and anionic gap are the independent risk factors of poor short-term prognosis in patients with AE and the combination of these 5 indexes can sufficiently predict the poor short-term prognosis in patients with AE.

Research progress of advance care planning for elderly hemodialysis patients / 中国实用护理杂志

With the rapid development of hospice care, more and more people pay attention to the quality of life of patients at the end of life. Due to the dialysis-related complications, heavy burden of comorbidities and cognitive impairment, elderly hemodialysis patients have poor quality of life, which brings heavy physiological, psychological and economic burdens to patients, families and society. Advance care planning can improve patients′ quality of life and save limited medical resources. By referring to relevant literature at home and abroad, this paper reviewed the overview of advance care planning, the necessity of discussing advance care planning with elderly hemodialysis patients, the implementation status and the obstacle factors. The purpose was to provide theoretical reference for better implementation of intervention treatment in elderly hemodialysis patients in China in the future.

Clinical features and prognosis of primary myelofibrosis with hepatic vascular disease and/or portal hypertension / 临床肝胆病杂志

Objective To investigate the clinical features, liver histopathological features, treatment, and prognosis of primary myelofibrosis (PMF)-associated hepatic vascular disease and portal hypertension. Methods A retrospective analysis was performed for the clinical and pathological features of 68 patients who were diagnosed with PMF in 960 Hospital of the PLA Joint Logistics Support Force and Xijing Hospital of Digestive Diseases, Air Force Medical University, from July 2010 to December 2020, among whom 22 patients had hepatic vascular disease/portal hypertension as the main manifestation. The patients were divided into two groups according to the presence or absence of thrombosis, and treatment and prognosis were summarized. The Kaplan-Meier method was used to plot survival curves, and the log-rank test was used to compare long-term survival rate between the two groups. Results Among the 68 patients with PMF, 22 had hepatic vascular disease and/or portal hypertension, resulting in a prevalence rate of 32.35%, and among these 22 patients, 13 (59.1%) had extrahepatic portal vein occlusion, 1 (4.5%) had Budd-Chiari syndrome, and 8 (36.4%) had portal hypertension. Biopsy was performed for 7 patients, and pathological results showed extramedullary hematopoiesis in the liver and varying degrees of infiltration of lymphocytes, plasma cells, and eosinophils at the lobular and portal areas, but the lobular structure was normal. A total of 7 patients died during follow-up, among whom 5 died of complications associated with thrombosis or portal hypertension. The overall median survival time was 57.99 months for all patients; the median survival time was 45.33 months in patients with thrombosis and 64.00 months in patients without thrombosis, and although there was no significant difference between the two groups ( χ 2 =3.035, P =0.081), the non-thrombosis group tended to have better survival and prognosis than the thrombosis group. Conclusion The possibility of PMF as the primary disease should be considered for patients with hepatic vascular disease and portal hypertension. Patients with PMF should be screened for hepatic vascular disease, and early intervention should be given. The patients without thrombosis tend to have better survival and prognosis than those with thrombosis.

Random flap with a retroauricular subcutaneous pedicle for reconstuction of anterior auricular conchal defect / 中华医学美学美容杂志

Objective:To observe the technique of using the random flap with a subcutaneous pedicle forone-stage reconstuction of anterior auricular conchal defect and its efficancy.Methods:Ten cases were involved in this study, including 3 cases of carcinoma, 6 cases of nevus, and one with iatrogenic detect. Six patients were men, and 4 were women. Their ages were 2 months to 68 years (mean 57 years). Surgical defect size ranged from 1.0 cm×1.0 cm to 2.5 cm×1.5 cm. They were resected and reconstructed using the retroauricular random flap of the subcutaneous pedicle.Results:10 wounds were healed by first intention. The appearance and functionality of the flap matched well with the receiptive site. During 6 to 24 months of follow-up, no tumor or nevus recurred. All patients were satisfied with the aesthetic results of the POSAS assessment scale.Conclusions:Aesthetic results are achieved with satisfactory appearance and functionality by this easy-to-learn technique in comparative short surgical time.