Current status of research on the genetic susceptibility of primary biliary cholangitis / 临床肝胆病杂志

Primary biliary cholangitis （PBC） is a liver autoimmune disease with a strong genetic tendency characterized by the degeneration and necrosis of bile duct epithelial cells， and it is often observed in middle-aged and elderly women. With the continuous development of genome-wide association studies， the genetic susceptibility of PBC has attracted more and more attention. This article elaborates on the research advances in the genetic susceptibility genes closely associated with PBC， in order to provide effective targets for the treatment of PBC.

Effectiveness of automated machine learning models in predicting the risk of preeclampsia in the first trimester / 中华健康管理学杂志

Objective:To explore the application value of automated machine learning (autoML) model in predicting the risk of preeclampsia in the first trimester.Methods:From January 2017 to October 2020, 2 180 singleton pregnant women who were registered in Jinan Second Maternal and Child Health Hospital and underwent pregnancy examination at 12 weeks of gestation were selected. The pregnant women were divided into preeclampsia group (103 cases) and control group (2 077 cases) according to the occurrence of preeclampsia. The differences in clinical data and hematological indexes in the two groups were compared, and the correlation between each index and the risk of preeclampsia was analyzed too. All the pregnant women were randomly divided into training set and test set according to the ratio of 7∶3, and the autogluon autoML algorithm was used to build a variety of machine learning models, and training and cross-validation were performed in the training set to compare the accuracy of the different models. The importance of each index in the autoML model was analyzed, and the autoML model and the logistic regression model were used to predict the risk of preeclampsia in pregnant women in the test set respectively, and the receiver operating characteristic (ROC) curve was used to evaluate the prediction performance of the autoML and the logistic regression model.Results:The age, pre-pregnancy body mass index, body mass index at 12 weeks of gestation, waist circumference at 12 weeks of gestation, proportion of drinking history, high-sensitivity C-reactive protein (hs-CRP), triglyceride, low-density lipoprotein cholesterol (LDL-C), aspartate aminotransferase (AST), platelet distribution width (PDW), mean platelet volume, thyroid stimulating hormone (TSH) and β-human chorionic gonadotropin were all significantly higher than those in the control group (all P<0.05), and the free tri-iodothyronine (free T3), free thyroxine (free T4), placental growth factor (PIGF), soluble fms-like tyrosine kinase-1 (sFlt-1) and pregnancy-associated plasma protein-A (PAPP-A) were all significantly lower than those in the control group (all P<0.05). Correlation analysis showed that the correlation between pre-pregnancy body mass index, body mass index at 12 weeks gestation, waist circumference at 12 weeks gestation, hs-CRP, triacylglycerol, AST, TSH, free T3, free T4, β-HCG, PIGF, sFlt-1, PAPP-A and preeclampsia risk were obviously higher; but the correlation between each index were lower. A total of 18 models in 8 categories were constructed with the autoML model algorithm, and the neural network _L2 based on FastAI had the highest accuracy in the training set (0.963) and the validation set (0.971). The TSH, LDL-C, PDW, waist circumference at 12 weeks of gestation, sFlt-1, AST were more important in the model, while the free T4, total cholesterol, pregnancy times, drinking history, parity and family history of hypertension were less important indicators. The area under the ROC curve of the autoML model for predicting the risk of preeclampsia in the first trimester was significantly higher than that of the logistic regression model (0.984 vs 0.765, P=0.002), while there was no statistical difference in the prediction accuracy of the two prediction models in the training set ( P>0.05). The prediction accuracy and sensitivity of the autoML model in the test set were both significantly higher than those of the logistic regression model (99.54% vs 98.32%, 93.75% vs 75.00%, both P<0.05). Conclusions:Factors such as TSH, LDL-C, PDW, waist circumference, sFlt-1 and AST in the first trimester of pregnancy have a certain correlation with the risk of preeclampsia. The autoML model based on the indicators of the first trimester has a high predictive value for the risk of preeclampsia.

Clinical blood use in Tibet Autonomous Region People′s Hospital: A respective study of 2014~2018 / 中国输血杂志

【Objective】 To retrospectively investigate the clinical transfusion status in Tibet Autonomous Region People′s Hospital, in order to provide data basis for further improvement of the rational and scientific blood use in our hospital. 【Methods】 Medical records of transfusion recipients in our hospital from 2014 to 2018 were investigated via HIS system, and such indicators as total clinical blood use, usage of whole blood and blood components, blood transfusion per capita, usage of blood components with different types. and the usage of red blood cells and plasma in each clinical department were retrospectively analyzed. 【Results】 The total clinical blood usage of our hospital increased from 3 930.5 U in 2014 to 4 949 U in 2018, with an annual growth rate of 5.93%. The average blood use per capita in 2014 and 2018 was 0.205 U vs 0.218 U, and incidence of blood component transfusion was 47.18% vs 99.02% The proportion of blood component (red blood cell and plasma) usage was 36.0%, 35.9%, 20.7% and 7.4% for blood type O, A, B and AB, respectively. The usage of total blood, red blood cell and plasma in internal and surgical departments were 13 883.8 U vs 7 080.8 U, 4 963.3 U vs 3 647.3 U and 6 055 U vs 1 170 U, respectively. 【Conclusion】 The total clinical blood usage and the proportion of blood component transfusion in our hospital is increasing year by year. Therefore, rational and scientific blood use should be further improved.

Analysis of polysomnography results between pre- and post-operation in pediatric obstructive sleep apnea hypopnea syndrome patients / 中华耳鼻咽喉头颈外科杂志

Objective@#To determine the objective effects of adenotonsillectomy on pediatric obstructive sleep apnea hypopnea syndrome (OSAHS) through analyzing the polysomnography (PSG) results between pre and post-operation.@*Methods@#A total of 56 pediatric OSAHS patients were included who underwent adenoidectomy or/and tonsillectomy and completed PSG follow-up from January 1, 2017 to March 31, 2018. All the pediatric patients who underwent adenoidectomy or/and tonsillectomy during the research period were arranged to take a preoperative PSG study. Patients who were diagnosed OSAHS would be encouraged to complete a follow-up PSG study ranged from1 to 3 months after surgery. The parameters of respiration and sleep architecture of PSG were compared and analyzed. The paired student t test was used to compare preoperative and postoperative mean values. The unpaired student t test was used to compare quantitative variables among different groups. The rank sum test was used if the data were abnormal distribution.@*Results@#Totally 238 patients completed preoperative PSG study, 62 patients were diagnosed as pediatric OSAHS, 56 eligible patients finished post-operative PSG. Hypopnea was the majority in all type of respiratory events in 56.45% (35/62) subjects, while central apnea as the majority in 29.03% (18/62) subjects who can also get significant CAI decrease after surgery. However, obstructive apnea as the majority only exist in 14.52% (9/62) subjects. The short-term cure rate of pediatric OSAHS was 85.71% (48/56). The postoperative AHI, MAI, CAI, HI, ODI, LoSpO2, percentage of stage I sleep and arousal index were significantly decreased, however, the OAI was no statistical decrease. The percentage of stage Ⅱ and rapid eye movement (REM) sleep were significantly increased, while no significant change in percentage of slow wave sleep and sleep efficiency(t=2.32, P=0.017).@*Conclusions@#Pediatric OSAHS manifest different characteristics of respiratory events from that of adults. Adenotonsillectomy can significant decrease respiratory events and improve sleep architecture, however, there are still some patients who can′t be completely relieved with adenotonsillectomy.

Polysomnographic comparation between dexmedetomidine-induced sleep and natural sleep / 中华耳鼻咽喉头颈外科杂志

Objective@#To compare the parameters of polysomnography (PSG) in sleep structure and respiratory events between dexmedetomidine-induced sleep and natural sleep.@*Methods@#From April 2016 to September 2018, a total of 44 patients with obstructive sleep apnea (OSA) and 3 patients with simple snoring completed PSG monitor both in natural sleep and dexmedetomidine-induced sleep in Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tsinghua Changgung Hospital. The PSG parameters were statistically analysed with SPSS 22.0 software.@*Results@#The average dose of dexmedetomidine was (104.60±27.93) μg, and there was no significant difference between the induced-sleep efficiency and the natural sleep efficiency (82.14%±16.66% vs. 86.50%±9.18%, t=-1.559, P>0.05). There was no rapid eye movement(REM) stages in all 47 subjects and only 1 case of them had non-rapid eye movement(NREM) stage 3 in induced sleep. The percentage of NREM1 in total sleep time was statistically different between the two groups (42.10%±26.71% vs. 17.47%±11.68%, t=5.997, P<0.001),but there was no significant difference in the percentage of NREM2 in total sleep time between the two groups (56.96%±26.0% vs. 62.95%±9.03%, t=-1.521, P=0.135). About respiratory events, there were significant differences in apnea hypopnea index ((46.29±20.23)/h vs. (39.67±25.41)/h), obstructive apnea index (25.20[10.50,45.40]/h vs. 16.20[3.30,35.20]/h) between induced-sleep and natural sleep (t=2.297, Z=-3.008, all P<0.05), these difference were more significant in mild-to-moderate OSA. There were no statistically significant differences in central apnea index (0.00[0.00,2.80]/h vs. 0.40[0.10,1.20]/h), mixed apnea index (0.00[0.00,6.20]/h vs. 0.00[0.00,3.40]/h, hypopnea index (4.20[0.00,3.30]/h vs. 12.00[5.20,17.40]/h), Z=-0.110,-0.508,-1.544, all P>0.05). There were statistical differences in the lowest oxygen saturation (84.77%±7. 59% vs. 80.21%±11.62%, t=2.558, P=0.014).@*Conclusions@#There is no significant difference in sleep efficiency and NREM2 between dexmedetomidine induced sleep and natural sleep.NREM3 sleep is rare induced, but REM sleep is none of all. And dexmedetomidine induced sleep may aggravate obstructive sleep apnea, but not central apnea.

Effects of transcutaneous electrical acupoint stimulation and electro-acupuncture combined with local anesthesia on cerebral blood flow and brain function in CAS patients / 临床麻醉学杂志

Objective To investigate the effects of transcutaneous electrical acupoint stimulation (TEAS) and electro-acupuncture (EA) combined with local anesthesia on cerebral blood flow (CBF) and Brain function in CAS patients.Methods Eighty cases of CAS were randomly as signed into EA group (group A),TEAS group (group T) and sham group (group C).Patients in group A received EA at acupoints of Shuigou (GV26) and Baihui (GV20),Hegu (L14) and Waiguan (TE5) at the same side of the stenting before 30 min of operation.Patients in group T received TEAS at the same acupoints through self-adhesive skin electrodes.In group T and group A,stimulations were continued until the end of the operation.The patients in group C did not received EA or TEAS.Blood pressure (BP) and heart rate (HR) were maintained at + 10％-20％ of baseline.Preoperative and postoperative average Vm,PI,RI of middle cerebral artery were measured.The occurrence of hyperperfusion and preoperative and postoperative scores at 1 week,1 month,3 months National Institute of Health Stroke Scale and Global Assessment Scale were recorded.Results The Vm of groups A and T was significantly less than group C (P＜0.05).The incidence of hyperperfusion of groups A and T were 3.7％,0％ and 25.0％ respectively (P＜0.05).NIHSS score of group A and group T were lower than those of group C during postoperative 1 week,1 month,3 month (P＜0.05),while the difference between groups A and T had no statistical significance.GES score of group A and group T during postoperative 1 week improved significantly than that of group C (P＜0.05).Conclusion Both TEAS and EA combined with local anesthesia in CAS operation could reduce the increase of postoperative cerebral blood flow and the incidence of postoperative hyperperfusion,and obviously improve brain function during postoperative 1 week.Both TEAS and EA combined with local anesthesia could be a worthwhile anesthesia method in CAS patients.

A study on common bile duct primary suture after laparoscopic choledocholithotomy with bile duct decompression tube / 中华普通外科杂志

Objective To evaluate intraoperative placement of bile duct decompression drainage tube in CBD primary suture after laparoscopic choledocholithotomy.Methods 152 patients undergoing laparoscopic choledocholithotomy were divided into group A (placement of bile duct decompression drainage tube during operation,82 cases) and group B (no decompression drainage tube placement,70 casas).Results There was no significant difference in operative time and intraoperative bleeding between the two groups (P ＞ 0.05).In group B patients the abdominal drainage tube indwelling time,abdominal drainage volume,peritoneal drainage fluid bilirubin value,postoperative hospitalization time were significantly longer than group A,the difference was statistically significant (P ＜ 0.05).No recurrence of choledocholithiasis and biliary stricture were found in either groups.Conclusions Placement of bile duct decompression drainage tube in laparoscopic choledocholithotomy and CBD primary suture after laparoscopic choledochotomy can significantly reduce the incidence of biliary leakage and shorten the postoperative hospital stay.

Medicinal experience, toxicity and efficacy of five types of Yunnan ethnic medicine / 中国药理学与毒理学杂志

The five volumes of Annals of National Medicine in Yunnan contain more than 1040 kinds of ethnic medicines and national medicines experiene that are commonly used by 25 minority nationalities in Yunnan.Among them,there are 147 species of toxic drugs,including five with fatal toxicity,14 with strong toxicity,57 with toxicity,and 71 with mild toxicity.In order to guarantee the validity and safety of national drug use,Yunnan Institute of Materia Medica applied modern science and technology to study the safety,efficacy and pharmacognosy of 30 kinds of commonly used toxic folk drugs contained in Annals of National Medicine in Yunnan.This paper chooses five typical national medicinal herbs Stephania delavayi,Euphorbia neriifolia,Alocasia cucullata,Achillea wilsoniana and Chamaenerion angustifolium,and summarizes their national medicinal and toxicity experience.The results of acute toxicity test showed that the five national medicinal herbs are toxic.The pharmacodynamic experiments showed that S.delavayi has analgesic action,E.neriifolia has anti-inflammatory action,A.cucullata has analgesic and antitussive effects,Ach.wilsoniana has analgesic effect,and C.angustifolium has analgesic and anti-inflammatory effects.

Composition Analysis of Remaining Metal Particles on Ferrochrome Kitchen Knife / 法医学杂志

Objective To establish a feasible evaluation index and method to identify composition of re-maining metal particles on ferrochrome kitchen knife. Methods The small samples of remaining metal particles were rubbed fromthe knives using filter paper. The composition of remaining metal particles was detected by scanning electron microscopy and energy dispersive X-ray spectrometer (SE m-EDX ) and GSR particle analysis function, using mathematical methods to calculate the ratio (relative amount) of Fe and Cr in remaining metal particles. Results The ratio (relative amount) of Fe and Cr of remain-ing metal particles had significant differences among most ferrochrome kitchen knives (P<0.05). Conclu-sion U sing GSR particle analysis function to quantitatively detect the ratio (relative amount) of Fe and Cr of remaining metal particles on ferrochrome kitchen knife, which can establish the feasible evaluation method to estimate such injury tool.

Nursing care to patients undergoing NovaSure endometrial ablation / 现代临床护理

Objective To summarize the experience of nursing patients undergoing NovaSure endometrial ablation. Methods Two hundred and eleven patients with abnormal uterine bleeding claiming no need of giving birth,who were hospitalized in our hospital during August 2011 to April 2013,were managed with NovaSure endometrial ablation and nursing care was performed.Follow-ups were conducted for investigating the curative effects.Results All the patients lived through the operations,their life signs were stable.As for the adverse effects,124 of them had mild abdominal pains,7 medium-level or severe hypogastralgia,1 dizziness and nausea,10 uterial hematocele,and 1 cystitis.All of them got recovered after treatment.One-month follow-up after hospitalization showed a success rate of 98.0%.Conclusions NovaSure is a new approach to abnormal uterine bleeding.It is advantageous for its simplicity,shortness in operation duration,less trauma to patients and good effects.Meanwhile,preoperative mental care and cooperative care during operation may facilitate their recoveries.

Stydy on the changes of intraocular pressure in obstructive sleep apnea syndrome / 中国综合临床

Objective To compare the changes of intraocular pressure (IOP) in 24 hours between obstructive sleep apnea syndrome(OSAS) and the non-obstructive sleep apnea syndrome(non-OSAS).Methods Sixty patients with OSAS were divided into two groups:OSAS group(n =30) and non-OSAS group (n =30).The following indicators were detected:(1) Awake oxygen saturation ((HSaO2) ％),(2) The lowest oxygen saturation (LSaO2) ％) ; (3) Mean oxygen saturation ((MSaO2 ％)) ; (4) Oxygen desaturation index ((DI4),time/h:number of times that the hourly oxygen desaturation ≥ 4％) ; (5) The percentage of the time that oxygen saturation ≤ 90％ accounts the total time ((SIT90)％) and 24-hour IOP.IOP was measured from early morning 5:00 and measured once every four hours.The measurement results were compared between two groups.Results There was no significant difference on age ((62.60 ± 12.44) years old vs (65.20 ± 10.66)years old,t =1.48),Course of disease ((22.40 ± 6.88) month vs (25.49 ± 7.22) month,t =1.97),gender (The ratio of male to female is(20/10)vs (17/13),x2 =0.007) between the OSAS and the non-OSAS(P ＞0.05).Value of AHI(h-1) ((27.9 ±6.0) vs (2.5 ±1.1),t =8.78),LSaO2 ((74.7 ±11.7)％ vs (91.8 ±5.9)％,t=3.44),SIT90((13.2±12.4)％ vs(0.2±1.1)％,t=9.92) and ODI4(h-1) ((28.9 ±13.9)vs (6.1 ±4.1),t =8.09) of OSAS was significantly higher than that of non-OSAS(P ＜0.05 or P ＜0.01).Value of IOP of 21:00 o'clock((20.61±4.15)mm Hg vs(19.60 ± 4.03)mm Hg,t =2.18),1:00 o'clock((23.12 ±3.11)mm Hg vs (20.60 ± 3.29) mm Hg,t =4.64) and 5:00 o' clock ((22.82 ± 2.99)mm Hg vs (17.21 ±3.55) mm Hg,t =4.23) of OSAS was significantly higher than that of non-OSAS (P ＜ 0.05 or P ＜ 0.01).The wave ((10.40 ± 2.85)mm Hg vs (8.40 ± 2.55) mm Hg,t =4.15) and maximal ((23.60 ± 3.29) mm Hg vs (21.23 ±3.43)mm-Hg,t =2.60) value of IOP of OSAS was significantly higher than that of non-OSAS(P ＜0.05 or P ＜0.01).There was no significant difference on minimum of IOP between the OSAS and the non-OSAS ((13.20 ± 4.08)mm Hg vs (12.70 ± 4.22) mm Hg,t =0.54,P ＞ 0.05).Conclusion There are higher wave and maximal value of IOP in the patients of OSAS during the night.It is important to pay attention to IOP in order to protect those patients' visual function.

Effect of omega-3 polyunsaturated fatty acids diets after early over-feeding on expressions of ghrelin in gastric tissue and leptin in serum in adult rats / 中华临床营养杂志

Objective To observe ghrelin expression in gastric tissue and serum leptin level of the early over-fed rats given ω-3 polyunsaturated fatty acids (PUFAs) diets after weaning,and explore the effects of early over-feeding and diets intervention on the metabolic syndrome in adult rats.Methods Male Sprague-Dawley rats were divided into normal feeding group (NF group,10 per litter) or over-feeding group (OF group,3 per litter) in postnatal day 3,and then different diets were given after weaning (postnatal day 21).The OF group was separately given conventional diet (OF + Con group),high-fat diet (OF + HF group),or ω-3 PUFAs (OF + ω-3 group) ; while the NF group was separated into NF + Con group and NF + HF group.Body weight and food intake were recorded every week.In week 6 and week 16,glucose tolerance test was perforfmed.Serum leptin,ghrelin,and triglyceride were assayed by enzyme-linked immuno-absorbent assay.Ghrelin mRNA and protein levels in gastric tissue were quantified by real-time PCR and immunohistochemistry.Results At week 16,energy intake,body weight and glucose intolerance in OF + HF group were significantly higher than in NF + HF group (t =-3.453,P =0.014 ; t =-6.406,P =0.000 ; F =16.249,P =0.000),and serum triglycerides,ghrelin mRNA of gastric tissue were significantly higher than those of OF + Con group (t =4.72,P =0.005 ; t =8.486,P =0.000).At week 16,the serum leptin level in OF + Con group was higher than that in NF + Con group (t =-3.274,P =0.031),also higher in OF + HF group than that in OF + Con group (t =3.028,P =0.014).There were no significant differences in serum ghrelin and the area of ghrelin immuno-positive cells in the gastric tissue among groups.The above indicators in OF + ω-3 group were not different from those of NF + Con group.Conclusions Over-feeding during the lactation period may lead to high susceptibility to obesity and disordered glucose and lipid metabolism.It can also increase serum leptin and ghrelin mRNA expression in gastric tissue,aggravate leptin resistance and feeding control disorders.Dietary ω-3 PUFAs offered protection against excessive accumulation of adipose tissue,glucose intolerance,leptin resistance,and maintained normal levels of leptin and ghrelin.

Influence of psychological nursing on depression of patients with hypokalemic periodic paralysis / 中国实用护理杂志

Objective To know the influence of psychological nursing on depression of patients with hypokalemic periodic paralysis.Methods Evaluated the mental condition by SDS for 46 patients with hypokalemic periodic paralysis and 30 health control, and then carried out certain psychological nursing measures for patients.Divided 46 patients with hypokalemic periodic paralysis into the intervention group and the control group randomly.There were 23 cases in each group.Psychological nursing cares and routine cares was used in the two group respectively, and then compared the incidence rate of depression in the two groups.Results The negative emotion in the patients with hypokalemie periodic paralysis was significant more obvious than that of in the health control.After the psychological nursing intervention, the SDS scores in the intervention group was released significantly than themselves before the intervention and the scores in the control group in the same time.Conclusions Depression was a common phenomenon in patients with hypokalemic periodic paralysis, characteristic psychological nursing intervention can effective release this kind of negative emotion, and then improve their rehabilitation.

Roles of heat shock protein 90 in the blockage of H2S against cardiomyocyte injuries induced by chemical hypoxia / 中国病理生理杂志

AIM: To explore the roles of heat shock protein 90 (HSP90) in the blockage of hydrogen sulfide (H2S) against chemical hypoxia-mimetic agent (cobalt chloride, CoCl_2)-induced oxidative stress injuries in H9c2 cardiac cell. METHODS: H9c2 cells were treated with CoCl_2 to set up the chemical hypoxia-induced the model of cardiomyocyte injury. Sodium hydrosulfide (NaHS, a H2S donor) was added into medium for 30 min before CoCl_2 treatment. ATP content was detected by high performance liquid chromatogram (HPLC). Mitochondrial membrane potential (MMP) was measured by rhodamine123 (Rh123) staining and photofluorography. The activity of superoxide dismutase (SOD) was observed using a SOD kit. The expression of heme oxygenase-1 (HO-1) was evaluated by Western blotting. RESULTS: CoCl_2 at concentration of 600 μmol/L significantly reduced SOD activity, ATP level and MMP, and enhanced the expression of HO-1 in H9c2 cells. Pretreatment with 400 μmol/L NaHS dramatically inhibited the cytotoxicity induced by CoCl_2, increased SOD activity, ATP level and MMP, decreased HO-1 expression. 17-allylamino-17 demethoxygeldanamycine(17AAG), an inhibitor of HSP90, obviously blocked the inhibitory effect of H2S on the CoCl_2-induced cytotoxicity, reduced the levels of ATP and MMP, increased HO-1 expression. However, no significantly influence on SOD activity was observed. CONCLUSION: HSP90 may mediate the cardioprotection of H2S via inhibiting the oxidative stress induced by chemical hypoxia.

Distribution Characteristic and Drug Resistance Analysis of Pathogens in Infective Cases / 中华医院感染学杂志

OBJECTIVE To investigate the distribution and the drug resistance of pathogens in infective cases and to provide a foundation for reasonable application of antibacterials.METHODS The information of all bacterial cultures and susceptibility tests from the inpatients in the year of 2006 was analyzed.RESULTS A total of 336 strains of pathogens were isolated,and the pathogens causing lower respiratory tract infection rated the top(60.7%).The resistance rate of Acinetobacter baumannii was the highest in Gram-negative bacilli.It was 33.3% to imipenem,and more than 66.6% towards the other antibacterials.All Gram-positive cocci were sensitive to vancomycin.The resistance rate of Enterococcus and Staphylococcus aureus was more than 75% to the most antibacterials.CONCLUSIONS Inspecting pathogens and strengthening susceptibility tests are very important in reducing drug abuse,decreasing the resistance rate and raising the cure rate in hospital.