A study of the influence of the level of transvaginal birth experience on the timing of postpartum lactation initiation / 中国实用护理杂志

Objective:To investigate the current status of women′s level of birth experience and lactation initiation time and explore the effect of level of birth experience on lactation initiation time.Methods:This was a cross-sectional study. A convenience sampling method was used to select 622 maternal cases attending the Affiliated Hospital of Jining Medical College from November, 2020 to January, 2021, and the distribution of their labor experience level and lactation initiation time was investigated by questionnaire and follow-up assessment.Results:There were 622 women with transvaginal deliveries who had lactation initiation times of more than 72 h in 241 cases (38.75%). The scores for each dimension of the Childbirth Experience Questionnaire (CEQ) were (49.63 ± 8.58)points, and the scores for each dimension of CEQ were perceived safety, professional support, involvement and self-efficacy in descending order. The results of the correlation analysis showed that there was a negative correlation between the scores on each dimension of CEQ and the total score and lactation initiation time ( r values were -0.436 to -0.146, all P<0.01). Stratified regression analysis showed that after controlling for age, number of births, gestational weeks of labour, illness during pregnancy and labour analgesia as the underlying variables affecting lactation initiation time, the scores for self-efficacy, involvement, perceived safety and professional support in the CEQ all affected lactation initiation time after delivery ( t values were -6.76 to -2.02, all P<0.05). Conclusions:The birth experience and lactation of women who deliver via vaginal birth need to be taken into account. The more negative the birth experience, the longer the lactation initiation time. The women′s involvement in the birth process, their own competence, perceived safety and level of professional support are all valid influencing indicators of lactation initiation time.

Congenital alveolar synechiae with cleft palate: A case report / 口腔医学

@#An oral synechia is a fibrous or soft tissue adhesion between the maxilla and the mandible. These synechiae can appear at various locations in the oral cavity, with alveolar synechia being one of the manifestations. Alveolar synechia is a rare congenital deformity and often accompanied by additional congenital defects, such as cleft lip or palate, microglossia, micrognathia, or TMJ anomalies. Among these, cleft palate is the most common. A case of congenital alveolar synechiae with cleft palate is reported. The child is in good condition after surgical treatment. The etiology and treatment are discussed.

Post-stroke fatigue / 国际脑血管病杂志

Post-stroke fatigue is one of the common symptoms of stroke patients. Continuous fatigue will affect the rehabilitation of patients' limb functions, lead to the decline of daily living ability, and at the same time, make patients lack energy, lose the initiative of rehabilitation exercise, and seriously affect the quality of life and social function. This article reviews the epidemiology, clinical characteristics, evaluation scales, influencing factors, pathophysiological mechanism and treatment of post-stroke fatigue.

Cognitive impairment in patients with asymptomatic cerebral infarction and atrial fibrillation / 国际脑血管病杂志

Atrial fibrillation is one of the most common arrhythmia types. With the increase of age, atrial fibrillation will increase the incidence of silent cerebral infarction (SCI), and the correlation between them will lead to the aggravation of cognitive impairment. Atrial fibrillation can be regarded as an independent risk factor for accelerating cognitive impairment in patients with SCI, but the possible mechanism is not completely clear. Therefore, patients with atrial fibrillation should undergo MRI examination, find SCI in time and develop corresponding intervention measures in order to reduce or delay a series of subsequent negative effects. This article reviews the related cognitive impairment of SCI patients with atrial fibrillation.

Study on Effect of PSS⁃4 on Rapid Assessment of Stress in Patients With Functional Dyspepsia / 胃肠病学

Background: Patients with functional dyspepsia (FD) are accompanied by different degree of psychological stress, and clinicians usually have insufficient quantitative assessment of patients’psychological stress. Aims: To explore the effect of psychological stress assessed by 4-item perceived stress scale (PSS-4) and 10-item perceived stress scale (PSS-10) on dyspepsia symptoms, anxiety, depression, somatization and quality of life in FD patients. Methods: A total of 357 FD patients met Rome IV criteria from March 2021 to March 2022 at Affiliated Hospital of North Sichuan Medical College were recruited. Score of PSS-4, PSS-10, generalized anxiety disorder-7 (GAD-7), patient healthy questionnaire-9 (PHQ-9), adapted patient healthy questionnaire-15 (adapted PHQ-15), dyspepsia symptom severity (DSS), Nepean dyspepsia index-short form (NDI) were performed. Effects of PSS-4, PSS-10 on dyspepsia symptoms, anxiety, depression, somatization and quality of life in FD patients were analyzed. Results: Correlation analysis showed that PSS-4 (r=0.152, P=0.004) and PSS-10 (r=0.194, P=0.000) were correlated with DSS; PSS-4 (r=0.341, P=0.000) and PSS-10 (r=0.389, P=0.000) were correlated with adapted PHQ-15; PSS-4 (r=0.239, P=0.000) and PSS-10 (r=0.327, P=0.000) were correlated with NDI; PSS-4 (r= 0.561, P=0.000) and PSS-10 (r=0.680, P=0.000) were correlated with anxiety; PSS-4 (r=0.449, P=0.000) and PSS-10 (r= 0.524, P=0.000) were correlated with depression. Multiple linear regression analysis showed that psychological stress assessed by PSS-4 (β=0.180, P=0.000), DSS (β=0.390, P=0.000) and FD classification (β=-0.116, P=0.024) were the influencing factors of NDI, and the psychological stress assessed by PSS-10 (β=0.268, P=0.000), DSS (β=0.360, P=0.000) and FD classification (β=-0.116, P=0.021) were the influencing factors of NDI. Conclusions: Psychological stress assessed by PSS-4, PSS-10 have effects on anxiety, depression, somatization, DSS and NDI in FD patients, and PSS-4 is shorter. These results suggest that PSS-4 can be used clinically to assess quickly and initially the impact of psychological stress on FD patients.

Experimental analysis of clinical applicability of homemade in homogeneous phantom / 中国辐射卫生

@#<b>Objective</b> To conduct experimental analysis of clinical applicability of a homemade phantom which is equivalent to multiple tissue densities of human body. <b>Methods</b> Materials with densities close to bone, lung, cavity, and soft tissue were manufactured and combined to obtain a homemade in homogeneous phantom. The electron density of equivalent materials was compared with the organs. Ten lung cancer patients in our department were recruited for dose verification of intensity modulated radiation therapy in the homemade phantom and solid-water phantom. The two phantoms were compared for characteristics in dose verification, and the dosimetric differences of the homemade phantom between the calculated values on treatment planning systemand measured values were statistically analyzed by SPSS 21.0 software. <b>Results</b> In the dose verification, the gamma pass rates (3 mm/3%) were more than 90% using both the homemade phantom and solid-water phantom. The measured values in homemade phantom were larger than those in solid-water phantom, and the maximum deviation was 11.5%. The AD and RD values of gamma pass rate in dose verification showed no significant differences between the two phantoms (<i>P</i> > 0.05). <b>Conclusion</b> The homemade phantom meets the accuracy requirement of clinical application and can be used in dose verification of intensity modulated radiation therapy plan.

Metabolic engineering of yeasts for green and sustainable production of bioactive ginsenosides F2 and 3β,20S-Di-O-Glc-DM

Both natural ginsenoside F2 and unnatural ginsenoside 3β,20S-Di-O-Glc-DM were reported to exhibit anti-tumor activity. Traditional approaches for producing them rely on direct extraction from Panax ginseng, enzymatic catalysis or chemical synthesis, all of which result in low yield and high cost. Metabolic engineering of microbes has been recognized as a green and sustainable biotechnology to produce natural and unnatural products. Hence we engineered the complete biosynthetic pathways of F2 and 3β,20S-Di-O-Glc-DM in Saccharomyces cerevisiae via the CRISPR/Cas9 system. The titers of F2 and 3β,20S-Di-O-Glc-DM were increased from 1.2 to 21.0 mg/L and from 82.0 to 346.1 mg/L at shake flask level, respectively, by multistep metabolic engineering strategies. Additionally, pharmacological evaluation showed that both F2 and 3β,20S-Di-O-Glc-DM exhibited anti-pancreatic cancer activity and the activity of 3β,20S-Di-O-Glc-DM was even better. Furthermore, the titer of 3β,20S-Di-O-Glc-DM reached 2.6 g/L by fed-batch fermentation in a 3 L bioreactor. To our knowledge, this is the first report on demonstrating the anti-pancreatic cancer activity of F2 and 3β,20S-Di-O-Glc-DM, and achieving their de novo biosynthesis by the engineered yeasts. Our work presents an alternative approach to produce F2 and 3β,20S-Di-O-Glc-DM from renewable biomass, which lays a foundation for drug research and development.

The glycosyltransferases involved in triterpenoid saponin biosynthesis: a review / 生物工程学报

Triterpenoid saponins are widely used in medicine, health cares, cosmetics, food additives and agriculture because of their unique chemical properties and rich pharmacological activities. UDP-dependent glycosyltransferases (UGTs) are the key enzymes involved in triterpenoid saponin biosynthesis, and play important roles in the diversity of triterpenoid saponin structures and pharmacological activities. This review summarized the UGTs involved in plant triterpenoid saponin biosynthesis based on the sources of UGTs and the types of receptors. Moreover, the application of UGTs in heterologous biosynthesis of triterpenoid saponins based on synthetic biology was also discussed.

Clinical efficacy and safety of omalizumab in the treatment of chronic spontaneous urticaria / 中华皮肤科杂志

Objective:To evaluate the clinical efficacy and safety of omalizumab in the treatment of chronic spontaneous urticaria (CSU) .Methods:Clinical data were collected from 60 patients, who were diagnosed with CSU and received subcutaneous injections of omalizumab at a dose of 300 mg once every 4 weeks for 3 sessions in Hospital of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College from March 2020 to September 2020, and retrospectively analyzed. At weeks 0, 2, 4, 6, 8, 10 and 12, urticaria activity score over 7 days (UAS7) and chronic urticaria quality of life (CU-Q2oL) score were used to evaluate clinical symptoms and quality of life of patients. Changes in the use of other drugs were evaluated before and after the treatment with omalizumab. Paired t test was used to compare UAS7 or CU-Q2oL score before and after treatment. Results:All the 60 CSU patients received 12 weeks of omalizumab treatment. The baseline UAS7 score was 22.37 ± 8.88 points; after one session of the treatment, the UAS7 score dropped to 2.01 ± 5.13 points, reaching the treatment plateau; at week 12, it dropped to 0.6 ± 2.63 points, and 0 point (complete control) in 93.3% of the patients, 1-6 points (favorable control) in 3.3%; the time required for UAS7 score to decrease to 0 point was 22.4 ± 3.2 days. The baseline CU-Q2oL score was 34.10 ± 15.01 points; after one session of the treatment, the CU-Q2oL score dropped to 2.41 ± 7.18 points, reaching the treatment plateau; at week 12, it was 0.56 ± 2.90 points; the time required for CU-Q2oL score to drop to 0 point was 21.15 ± 16.02 days. After the combination treatment with omalizumab, a gradual decrease in dosage or withdrawal of previous therapeutic drugs was realized. At week 12, 39 patients (65%) achieved complete control, and withdrew all therapeutic drugs except omalizumab. During the treatment and follow-up, omalizumab showed good safety, and no adverse reactions were observed.Conclusion:Omalizumab at a dose of 300 mg once every 4 weeks is markedly effective and safe for the treatment of CSU, providing a new treatment option for CSU patients with poor response to traditional therapy.

Development and clinical evaluation of intelligent vision examination and management system based on mobile terminal / 中华实验眼科杂志

Objective:To develop an intelligent vision examination and management system based on mobile terminal, and evaluate its practical application.Methods:A diagnostic test study was adopted.Fifty children and adolescents (100 eyes) aged from 3 to 14 years, with an average age of (8.16±4.58) years, were enrolled in Zhongshan Ophthalmic Center from March to May, 2020.An intelligent vision examination and management system for Android and IOS devices, which applied technologies of real-time range measurement, speech recognition, and gesture recognition to achieve the real-time interaction in the vision examination, was developed using JAVA language and xcode11.The uncorrected visual acuity of subjects was tested with the intelligent vision system and the standard eye chart in hospital.The difference in the number of cooperative eyes between the two methods was analyzed by χ2 test.The LogMAR acuity of the two methods were compared by Wilcoxon rank sum test and the consistency between the two methods was analyzed by Kappa test.The study adhered to the Declaration of Helsinki, and the study protocol was approved by an Ethics Committee of Zhongshan Ophthalmic Center (No.2020KYPJ095). Written informed consent was obtained from guardians of each subject prior to any examination. Results:The intelligent vision examination and management system was successfully developed for Android and IOS devices, which was loaded with precise vision examination at 3 meters, intelligent interaction, result output and automatic filing functionalities.The inspection range of visual acuity was from 0.1 to 1.5.The size and resolution of eye chart met the national standard.There was no significant difference in the number of cooperative eyes during examination between traditional eye chart (99/100) and intelligent vision examination system (98/100) ( χ2=0.338, P=0.561). There was no significant difference in examination results between traditional eye chart 0.3 (0.2, 0.5) LogMAR and intelligent vision examination system 0.3 (0.2, 0.5) LogMAR ( Z=-1.602, P=0.109), and there was a high consistency between the two methods (Kappa coefficient=0.885). Conclusions:The intelligent vision examination and management system based on the mobile terminal is of high accuracy and practicability, which can effectively meet the public demand for at-home vision testing and long-term tracking.The system can be promoted and applied as a new mode for personalized eye health management.

Effect of moderate exercise therapy and fracture liaison service on osteoporotic hip fracture / 中国实用护理杂志

Objective:To explore the clinical effect of moderate exercise therapy and fracture liaison service in osteoporotic hip fracture.Methods:From June 2018 to June 2020, 120 patients with osteoporotic hip fracture admitted to Nanjing Hospital Affiliated to Nanjing Medical University were selected. The patients were divided into study group and control group by random number table method, 60 cases in each group. The control group was treated with routine nursing and moderate exercise therapy, and the control group was treated with fracture liaison service, clinical observation and comparison of treatment compliance, bone mineral density (BMD), Numerical Rating Scale (NRS) score and nursing satisfaction before and after intervention.Results:The BMD and NRS scores in the study group were (0.90±0.25) g/cm 2, (1.0±0.3) points, higher than those in the control group (0.80±0.18) g/cm 2, (1.0±0.25) points. The difference was statistically significant ( t values were 2.514, 2.547, P<0.05). The total compliance rate and nursing satisfaction of the study group were 93.30% (56/60) and 95.00% (57/60) respectively, which were significantly higher than 80.00% (48/60) and 83.33% (50/60) of the control group. The difference was statistically significant ( χ 2 values were 4.615, 4.227, P<0.05). Conclusion:Moderate exercise therapy and fracture contact service intervention can effectively improve bone mineral density and total compliance rate, relieve pain and improve nursing satisfaction.

Advances in biosynthesis of cadinane sesquiterpenes / 生物工程学报

Cadinanes are a class of bicyclic sesquiterpenes with complex stereochemistry and broad pharmacological activities, such as antibacterial, anti-inflammatory, and hypoglycemic activities. To date, structurally diverse and bioactive cadinane sesquiterpenes have been isolated and identified from a variety of plants and microorganisms. Moreover, deeper understandings on cadinane sesquiterpene synthases have been made. This article categorized the 124 new cadinanes which were published in the literatures in the past four years (2017-2020) into five structural types, and presented their pharmacological activities. We also illustrated the elucidation of the biosynthetic pathways for typical cadinanes, summarized the research progress on cadinane sesquiterpene synthases. Finally, current challenges and future prospects were proposed and discussed.

Synthetic biology of plants-derived medicinal natural products / 生物工程学报

Medicinal natural products derived from plants are usually of low content and difficult to extract and isolate. Moreover, these compounds are structurally complex, making it difficult to obtain them by environmental unfriendly chemical synthesis. Biosynthesis of medicinal natural products through synthetic biology is a novel, environment-friendly and sustainable approach. Taking terpenoids (ginsenosides, paclitaxel, artemisinin, tanshinones), alkaloids (vincristine and morphine), and flavonoids (breviscapine) as examples, this review summarizes the advances of the biosynthetic pathways and synthetic biology strategies of plant-derived medicinal natural products. Moreover, we introduce the key technologies and methods of synthetic biology used in the research of medicinal natural products, and provide future prospects in this area.

Enlarged perivascular space / 国际脑血管病杂志

The perivascular space is formed by the pia mater around the blood vessels and participates in the fluid exchange and waste clearance in the brain. The enlarged perivascular space (EPVS) indicates the disorder of brain clearance mechanism, which is closely related to the occurrence and development of a variety of clinical diseases. In recent years, there are a lot of studies on the pathogenesis and influencing factors of EPVS. This article reviews its anatomy, neuroimaging, pathogenesis, and risk factors.

Establishment of HPLC Fingerprint of Chinese Gall Leaven and Content Determination of 5 Components / 中国药房

OBJECTIVE：To establis h HPLC fingerprint of Chinese gall leaven ，simultaneous determination of 5 components and optimization of distillers ’grains. METHODS ：HPLC method was adopted. The determination was carried out on Waters Symmetry Shield TM RP18 column with mobile phase consisted of acetonitrile- 0.1％ trifluoroacetic acid aqueous （gradient elution ）at the flow rate of 0.8 mL/min. The column temperature was 30 ℃，and detection wavelength was set at 280 nm. The sample size was 5 µL. Using gallic acid as reference ，HPLC fingerprints of 14 batches of sample were drawn. The similarity evaluation was performed by using Similarity Evaluation System of Chromatogram Fingerprint of TCM （2012 edition）to determine common peaks；SPSS 20.0 software was used for cluster analysis. RESULTS ：There were 11 common peaks in 14 batches of samples ，and the similarity range of 14 batches of samples was 0.424-0.998，A1-A5 was less than 0.850；5 components were identified in B 1-B9 sample，i.e. gallic acid ，（－）-epigallocatechin，methyl gallate ，2，4，6-tri-O-galloyl-α-D-glucose and 2，4，6-tri-O-galloyl- β-D-glucose. The results of cluster analysis showed that 14 batches of samples could be grouped into 3 categories，i.e. A1-A5 into one category，B1 and B 6 into one category ，B2-B5 and B 7-B9 into one category. The linear ranges of above 5 components were 29.96-599.2 μg/mL（r＝0.999 6），0.832-416 μg/mL（r＝0.999 6），0.102-51 μg/mL（r＝0.999 8），0.286 4-143.2 μg/mL（r＝0.999 8）， 0.286 4- 143.2 μg/mL（r＝0.999 8），respectively. The limits of quantitation were 0.060，0.104，0.017，0.029，0.057 μg/mL；the limits of detection were 0.018，0.031，0.005，0.009，0.017 μg/mL，respectively. RSDs of precision ，stability，reproducibility and durability tests were all lower than 3％. The recoveries were 97.16％-101.88％（RSD＝1.60％，n＝6），96.98％-99.24％（RSD＝ 0.85％，n＝6），97.7％-101.64％（RSD＝1.54％，n＝6），97.77％-103.08％（RSD＝1.82％，n＝6），98.16％-101.88％（RSD＝1.24％， n＝6），respectively. CONCLUSIONS：The established HPLC fingerprint and cluster analysis can be used to evaluate the quality of Chinese gall leaven. The established method is simple to Δ 基金项目：国家重点研发计划项目（No.2018YFC1707200）；公 operate and can be used to determine the contents of 5 益性行业科研专项项目（No.201507004-03）；河南中医药大学研究生 components simultaneously ；rice husk distillers ’grains were 科研创新基金项目（No.YJS2018B14） ＊硕士研究生 。研究方向 ：中药饮片及新药研究 。E-mail： not suitable for fermented Chinese gall leaven . 401327039@qq.com

Analysis on the content and mode of family doctor contract service in the mountain area of northern Beijing / 中华医院管理杂志

Objective:To understand the development of family doctor contract service and the actual demand of local residents for contract service, so as to provide the basis for the establishment of family doctor contract service mode suitable for mountainous residents.Methods:Based on the relevant policy requirements of family doctor contract service, a questionnaire and an interview outline were developed. A questionnaire survey was conducted among 583 residents of each township health center in all eight townships in the mountainous area north of Huairou District, and 16 residents were interviewed in depth in September 2019. The count data were analyzed by composition ratio, frequency description and ranking. The content analysis of qualitative interview data was carried out by topic frame method.Results:133 residents(22.8%) were unaware of the family doctor contract system at all, and 164(28.1%) knew a little about it. Residents′ lack of awareness tend to affect their medical seeking behavior. 361 residents(61.9%) knew that they had signed agreements with family doctors. Residents were not active enough to sign contracts, and their demand for family doctor signing service was mainly for various kinds of door-to-door services, and the demand for online service was low.Conclusions:The contract service relationship between residents and family doctors in mountainous areas is not working as desired. We should actively explore the contract service mode and performance evaluation mode suitable for the characteristics of mountain areas, so as to promote the healthy development of family doctor contract service.

Lenalidomide plus dexamethasone for proliferative glomerulonephritis with monoclonal immunoglobulin deposits / 中华肾脏病杂志

Objective:To evaluate the efficacy and safety of lenalidomide plus dexamethasone (LD) in patients with proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID).Methods:The clinicopathological data of PGNMID patients who were treated with LD protocol from January 2010 to October 2019 were retrospectively analyzed.Results:All of 6 patients received LD treatment for≥3 months after renal biopsy in Jinling Hospital. During the follow-up period of 6 to 19 months, 3 patients achieved renal remission, and the renal remission rate was 50%(3/6). Light microscopy showed membranoproliferative glomerulonephritis and immunofluorescence showed single kappa type IgG3 was deposited in the mesangial region and the vascular loop. Before taking LD scheme, the median urinary protein were 7.76(1.27, 14.57) g/24 h, the median serum creatinine was 118.5(70.7, 289.1) μmol/L, and the median albumin was 34.5(22.4, 37.5) g/L. The concentration of serum free kappa and lambda light chain was increased in 5 patients, but the serum free light chain ratio was normal. Hypocomplementemia was detected in two cases. Six patients underwent bone marrow flow cytometry, and 2 patients had elevated monoclonal plasma cells, accounting for 0.7% and 0.5%, respectively. Immunofixation electrophoresis suggested that 1 patient had positive serum M protein for kappa type IgG3. At the last follow-up, median urine protein was 3.33(0.33, 11.23) g/24 h, median serum creatinine was 108.7(80.4, 160.9) μmol/L, and median albumin was 35.9(24.5, 45.6) g/L. The concentration of serum free light chain in 4 patients from 5 patients with elevated serum free light chain was lower than that before taking the drug. Decreased level of serum complement in two cases returned to normal after treatment. The M spike did not turn negative during the follow-up in one patient. Adverse events included anemia, neutropenia, limb numbness and upper respiratory tract infection.Conclusion:This study reports for the first time that LD protocol may be effective in treating PGNMID, but more attention should be paid to the hematological adverse events of lenalidomide.

Analysis of risk factors for osteoporosis in patients with pemphigus treated with systemic glucocorticoids / 中华皮肤科杂志

Objective:To investigate the incidence of and risk factors for osteoporosis in patients with pemphigus treated with systemic glucocorticoids, and to analyze the current status of prevention and treatment of osteoporosis.Methods:Clinical data were collected from 101 inpatients with pemphigus treated in Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College from January 2014 to January 2019, and these patients were divided into osteoporosis group ( n= 21) and non-osteoporosis group ( n= 80) according to their bone mineral density (BMD) values. Correlations of osteoporosis with patients′ general information, treatment duration and cumulative dose of glucocorticoids, application of immunosuppressive agents, diabetes mellitus, hypertension, hyperlipidemia, smoking, outdoor activity and other factors were analyzed, and the application status of calcium supplements, vitamin D and bisphosphonates was also analyzed. Enumeration data were compared by using chi-square test, measurement data were compared by using t test, and multiple factors influencing osteoporosis were analyzed by using non-conditional Logistic regression analysis. Results:Logistic regression analysis showed that age ( P= 0.001, OR= 1.08, 95% CI: 1.03- 1.14) and cumulative dose of glucocorticoids ( P<0.001, OR= 1.72, 95% CI: 1.18- 2.52) were risk factors for the occurrence of osteoporosis, while outdoor activity ( P<0.001, OR= 0.04, 95% CI: 0.01- 0.21) was a protective factor. Moreover, 13 (61.9%) patients in the osteoporosis group and 16 (21.6%) patients in the non-osteoporosis group received combination treatment with calcium supplements, vitamin D and bisphosphonates. Conclusions:Pemphigus patients treated with systemic glucocorticoids are prone to develop osteoporosis. Older age, cumulative dose of glucocorticoids may be risk factors for osteoporosis in patients with pemphigus, while outdoor activity may be a protective factor. The prevention and treatment of osteoporosis in pemphigus patients are still not standardized.

Predictive factors and follow-up treatment of residual cervical lesions after primary cervical conization / 中国医师进修杂志

Objective:To explore the necessity of supplementary operation after primary cervical conization for cervical lesions and the choosing method of reoperation, so as to provide clinical data for further stratification treatment after primary conization.Methods:A prospective study was performed in 116 patients with complete data due to cervical biopsy diagnosis of cervical lesions who first received cervical conization, and received supplementary surgeries within 6 months at Wenzhou People Hospital from March 2016 to March 2018, and 17 cases who received radical resection diagnosed grade Ⅰa1 with vascular infiltration or above were excluded. The patients were divided into residual and non-residual according to residual disease of supplementary surgical specimens. The residual rates of clinical and pathological factors (including incision margin, gland involvement, curettage of cervical canal) were analyzed by univariate analysis. The factors of P ≤ 0.10 were further analyzed by progressive Logistic regression. The clinical and pathological data of 41 patients undergoing repeated conization were analyzed. The follow-up data were analyzed and summarized. Results:Univariate analysis showed that the residual rate of disease in the patients with positive margin, endocervical cone margin involvement and other positive margin was 55.36% (31/56), 63.64% (14/22) and 50.00% (17/34), respectively, higher than that of the patients with negative margin 30.00% (18/60) with statistical significance ( P<0.05). There was no significant difference in pregnancy (≥ 3), parity (≥ 2), symptomatic cases between the two groups, but all P < 0.10. Multivariate analysis showed that both endocervical cone margin involvement and vaginal incision margin were independent risk factors for residual disease, and OR was 4.083 (95% CI 1.459 to 11.430, P = 0.007) and 2.333 (95% CI 0.978 to 5.569, P = 0.056); 19 cases (46.34%) of cervical lesions and 11 cases (26.83%) of high-grade cervical lesions were found in 41 cases after repeated conization. 2 cases (4.88%) of positive margin of incision were supplemented with total hysterectomy; the incidence of intraoperative massive bleeding was 4.88% (2/41). The incidence of massive hemorrhage after operation was 2.43% (1/41). Conclusions:Margin involvement and vaginal incision margin might predict the occurrence of residual disease. Additional surgery should be considered in these cases. Repeat conization can remove residual cervical lesions with minimal trauma and can be used as the preferred treatment.

Survey of application value on an intelligent consultation system for common eye diseases / 中华实验眼科杂志

Objective:To survey the application of an intelligent consultation system for common eye diseases and evaluate its applicational effectiveness on an internet hospital platform.Methods:A cross-sectional study was performed in Zhongshan Ophthalmic Centre of Sun Yat-sen University.Natural language processing technology was applied to develop the intelligent consultation system for common eye diseases.Its efficiency and quality were evaluated.The survey data were collected from February 1 to 29, 2020 to analyze the demographic information, consultation time, consultation category, consultation content, service satisfaction.This study protocal was approved by an Ethic Committee of Zhongshan Ophthalmic Centre of Sun Yat-sen University(2020KYPJ095).Results:The intelligent consultation system for common eye diseases was developed and successfully deployed in Internet Hospital of Zhongshan Ophthalmic Center.The repeatability and accuracy of the intelligent consultation system were 100.0% and 99.8%, respectively.During February 1 to 29, 2020, the intelligent consultation system served 6 462 patients, including 3 082 males(47.7%) and 3 380 females(52.3%). The average age of patients was 32.3 years old.Total of 1 135(17.6%) patients used the intelligent guidance consultation, and 5 375(82.4%) patients used the intelligent outpatient consultation.The intelligence consultation system was applied by 223 patients per day with a maximum of 74 patients per hour.The survey showed that 25.6% and 36.4% of the patients felt very satisfied and relatively satisfied with the efficiency of the intelligent consultation service, respectively; 24.3% and 37.8% of the patients were very satisfied and relatively satisfied with the quality of the intelligent consultation service, respectively.Conclusions:Intelligent consultation system for common eye diseases can meet the needs of patients because of its high repeatability and accuracy.Patients are satisfied with the service efficiency and quality of the intelligent consultation system, which avoids the risk of cross infection and releases the burden of medical staff.