Application effect analysis of lateral prone position ventilation in patients with acute respiratory distress syndrome / 中华危重病急救医学

OBJECTIVE@#To investigate the effect of lateral prone position ventilation in patients with acute respiratory distress syndrome (ARDS).@*METHODS@#A prospective control study was conducted. A total of 75 patients with moderate to severe ARDS admitted to the department of critical care medicine of Jingxian Hospital in Anhui province from January 2020 to December 2022 were selected as the research objects. According to the envelope method, the patients were divided into the lateral prone position ventilation group (38 cases) and the traditional prone position ventilation (PPV) group (37 cases), using lateral prone position ventilation and traditional PPV, respectively. The mechanical ventilation parameters were set according to the ARDS treatment guidelines and lung protective ventilation requirements in both groups, and the time of prone position for the first 3 times was not less than 16 hours per day. General data of patients were recorded, including heart rate (HR), mean arterial pressure (MAP), airway resistance and lung static compliance (Cst) before prone position (T0), 1 hour (T1), 4 hours (T2), 8 hours (T3), and before the end of prone position (T4), oxygenation index (PaO2/FiO2) before the first prone position (t0) and 12 hours (t1), 24 hours (t2), 48 hours (t3), and 72 hours (t4) after the intensive care unit (ICU) admission, as well as the incidence of pressure injury (PI) and vomiting, tracheal intubation time, and mechanical ventilation time. Repeated measures analysis of variance was used to compare the effects of different prone positions on patients before and after the prone position.@*RESULTS@#There were no significant differences in age, gender, body mass index (BMI), acute physiology and chronic health evaluation II (APACHE II), underlying diseases, HR, MAP, pH value, PaO2/FiO2, blood lactic acid (Lac), arterial blood pressure of carbon dioxide (PaCO2) and other general information between the two groups. The HR (intergroup effect: F = 0.845, P = 0.361; time effect: F = 1.373, P = 0.247; interaction: F = 0.245, P = 0.894), MAP (intergroup effect: F = 1.519, P = 0.222; time effect: F = 0.169, P = 0.954; interaction: F = 0.449, P = 0.773) and airway resistance (intergroup effect: F = 0.252, P = 0.617; time effect: F = 0.578, P = 0.679; interaction: F = 1.467, P = 0.212) of T0-T4 between two groups showed no significant difference. The Cst of T0-T4 between the two groups showed no significant difference in the intergroup effect (F = 0.311, P = 0.579) and the interaction (F = 0.364, P = 0.834), while the difference in the time effect was statistically significant (F = 120.546, P < 0.001). The PaO2/FiO2 of t0-t4 between the two groups showed no significant difference in the intergroup effect (F = 0.104, P = 0.748) and the interaction (F = 0.147, P = 0.964), while the difference in the time effect was statistically significant (F = 17.638, P < 0.001). The group factors and time factors were tested separately, and there were no significant differences in the HR, MAP, airway resistance, Cst, PaO2/FiO2 between the two groups at different time points (all P > 0.05). The Cst at T1-T4 and PaO2/FiO2 at t1-t4 in the two groups were significantly higher than those at T0/t0 (all P < 0.05). There were no significant differences in the tracheal intubation time [days: 6.75 (5.78, 8.33) vs. 7.00 (6.30, 8.45)] and mechanical ventilation time [days: 8.30 (6.70, 9.20) vs. 7.40 (6.80, 8.75)] between the lateral prone position ventilation group and the traditional PPV group (both P > 0.05). However, the incidences of PI [7.9% (3/38) vs. 27.0% (10/37)] and vomiting [10.5% (4/38) vs. 29.7% (11/37)] in the lateral prone position ventilation group were significantly lower than those in the traditional PPV group (both P < 0.05).@*CONCLUSIONS@#Both lateral prone position ventilation and traditional PPV can improve Cst and oxygenation in patients with moderate to severe ARDS. The two types of prone position have little influence on HR, MAP and airway resistance of patients, and there is no difference in the influence on tracheal intubation time and mechanical ventilation time of patients. However, the lateral prone position ventilation mode can reduce the incidence of PI and vomiting, and is worthy of clinical promotion and application.

Benefits of Mindfulness Training on the Mental Health of Women During Pregnancy and Early Motherhood: A Randomized Controlled Trial / 生物医学与环境科学（英文）

OBJECTIVE@#This study aimed to evaluate the effects of a mindfulness-based psychosomatic intervention on depression, anxiety, fear of childbirth (FOC), and life satisfaction of pregnant women in China.@*METHODS@#Women experiencing first-time pregnancy ( n = 104) were randomly allocated to the intervention group or a parallel active control group. We collected data at baseline (T0), post-intervention (T1), 3 days after delivery (T2), and 42 days after delivery (T3). The participants completed questionnaires for the assessment of the levels of depression, anxiety, FOC, life satisfaction, and mindfulness. Differences between the two groups and changes within the same group were analyzed at four time points using repeated-measures analysis of variance.@*RESULTS@#Compared with the active control group, the intervention group reported lower depression levels at T2 ( P = 0.038) and T3 ( P = 0.013); reduced anxiety at T1 ( P = 0.001) and T2 ( P = 0.003); reduced FOC at T1 ( P < 0.001) and T2 ( P = 0.04); increased life satisfaction at T1 ( P < 0.001) and T3 ( P = 0.015); and increased mindfulness at T1 ( P = 0.01) and T2 ( P = 0.006).@*CONCLUSION@#The mindfulness-based psychosomatic intervention effectively increased life satisfaction and reduced perinatal depression, anxiety, and FOC.

Effect of Ganmai Dazao Decoction on ethology of rats with PTSD and its mechanism / 中国中药杂志

This study aimed to explore the effect of Ganmai Dazao Decoction on the ethology of rats with posttraumatic stress disorder(PTSD) and study the related mechanism through the changes in magnetic resonance imaging and protein expression. Sixty rats were randomly divided into 6 groups, namely the normal group, the model group, the low(1 g·kg~(-1)), medium(2 g·kg~(-1)), and high-dose Ganmai Dazao Decoction groups(4 g·kg~(-1)), and the positive control group(intragastric administration with 10.8 mg·kg~(-1) of fluoxetine), with 10 rats in each group. Two weeks after inducing PTSD by single-prolonged stress(SPS) in rats, the positive control group was given fluoxetine hydrochloride capsule by gavage, the low, medium, and high-dose groups were given Ganmai Dazao Decoction by gavage, and both the normal group and the model group were given the same volume of normal saline by gavage, each for 7 days. The open field experiment, elevated cross elevated maze, forced swimming experiment, and new object recognition test were carried out for the behavioral test. Three rats in each group were selected to detect the expression of neuropeptide receptor Y1(NPY1R) protein in the hippocampus by Western blot. Then, the other three rats in each group were selected to use the 9.4T magnetic resonance imaging experiment to observe the overall structural changes in the brain region and the anisotropy fraction of the hippocampus. The results of the open field experiment showed that the total distance and central distance of rats in the model group were significantly lower than those in the normal group, and the total distance and central distance of rats in the middle and high-dose Ganmai Dazao Decoction groups were higher than those in the model group. The results of the elevated cross maze test showed that medium and high-dose Ganmai Dazao Decoction remarkably increased the number of open arm entries and the residence time of open arm of rats with PTSD. The results of the forced swimming experiment showed that the immobility time in the water of the model group rats was significantly higher than that of the normal group, and Ganmai Dazao Decoction hugely reduced the immobility time in the water of rats with PTSD. The results of the new object recognition test showed that Ganmai Dazao Decoction significantly increased the exploration time of new objects and familiar objects in rats with PTSD. The results of Western blot showed that Ganmai Dazao Decoction significantly reduced the expression of NYP1R protein in the hippocampus of rats with PTSD. The 9.4T magnetic resonance examination found that there was no significant difference in the structural image among the groups. In the functional image, the fractional anisotropy(FA value) of the hippocampus in the model group was significantly lower than that in the normal group. The FA value of the hippocampus in the middle and high-dose Ganmai Dazao Decoction groups was higher than that in the model group. Ganmai Dazao Decoction reduces the injury of hippocampal neurons by inhibiting the expression of NYP1R in the hippocampus of rats with PTSD, thereby improving the nerve function injury of rats with PTSD and playing a neuroprotective role.

Analysis of the pathogenesis and risk factors of gallstone / 中华外科杂志

Objective: To explore the pathogenesis and risk factors of gallstone formation. Methods: The findings of hepatobiliary ultrasound and related data were collected from healthy subjects who underwent a physical examination at Xuanwu Hospital of Capital Medical University from January 2012 to December 2021. A total of 98 344 healthy subjects were included in the study,including 48 241 males and 50 103 females,with a ratio of 1∶1.03,aged (42.0±15.6)years(range:14 to 97 years). The gender,age,body mass index,waist circumference,systolic pressure,diastolic pressure,ALT,AST,total bilirubin,fasting blood glucose,triglyceride,total cholesterol,low-density lipoprotein,high-density lipoprotein were collected.Healthy subjects were required to sit for at least 10 minutes before blood pressure was measured.Rresults of fasting venous blood were collected after 8 to 12 hours on an empty stomach.According to the presence of gallstones by ultrasound results, healthy subjects were divided into study group and control group. Data were analyzed by rank-sum tests and χ2 test, and risk factors for gallstone formation were explored by Logistic regression analysis. Results: The incidence of gallstones in this group was 5.42%(5 333/98 344). Among them,the incidence of gallstones in people aged 60 years and above was significantly higher than that in people under 60 years old(15.31%(2 348/15 334) vs. 3.60%(2 985/83 010), χ2=3 473.46,P<0.05).The healthy subjects were divided by age for every 10 years,and the results showed that the incidence of gallstones increased with age. The incidence of gallstones in females was 5.68%(2 844/50 103),greater than 5.16%(2 489/48 241) in males(χ2=11.81,P<0.05). Among them,1 478 cases underwent gallbladder surgical resection due to gallstones,and the operation rate was 27.71%. The operation rate reached the peak between 60 and <70 years old,and decreased after 70 years old. The results of the multivariate analysis showed that,female(OR=1.38, P<0.01),age(OR=1.58, P<0.01),body mass index≥24 kg/m2(OR=1.31, P<0.01),waist circumference≥85 cm(OR=1.24, P<0.01),fasting blood glucose>6.1 mmol/L(OR=1.18,P<0.01),total cholesterol≥5.18 mmol/L(OR=0.87, P=0.019),low-density lipoprotein≥3.37 mmol/L(OR=1.15,P=0.001) were the risk factors for gallstone formation;high-density lipoprotein≥1.55 mmol/L(OR=0.87, P<0.01) was a protective factor for gallstone formation. Conclusions: The incidence of gallstones increases with age in male and female. Gender,age,body mass index,waist circumferenc,fasting blood glucose,total cholesterol,LDL,and HDL are related factors with gallstone formation.

Immediate postoperative color Doppler ultrasonography on the diagnosis of hemorrhagic complications of liver biopsy and its directed compression hemostasis / 中华肝脏病杂志

Objective: To study the diagnostic value of immediate color Doppler ultrasonography on traumatic hepatic hemorrhage after tissue sampling with ultrasound-guided liver biopsy and the clinical effect of its-directed local compression hemostasis at puncture-site. Methods: 132 hospitalized patients with various liver diseases underwent ultrasound-guided hepatic puncture-biopsies, including 61 cases with diffuse parenchymal and 71 cases with focal liver lesions. Immediate postoperative color Doppler ultrasonography was performed following liver biopsy. Abnormal blood flow signal was observed at hepatic puncture biopsy site, and if there were hemorrhagic signals, ultrasound-directed local compression hemostasis was performed until the bleeding signal disappeared. F-test and Chi-square test were used for statistical analysis. Results: Immediate color Doppler ultrasonography showed traumatic hemorrhage in 36.1% (22/61) and 40.8% (29/71) cases of diffuse liver disease and focal liver disease group, respectively. All hemorrhagic signals were eventually disappeared after ultrasound-directed local compression hemostasis. The median hemostasis time was 2 min in both groups, and there was no statistically significant difference in bleeding rate and hemostasis time between the two groups (P>0.05). There were no serious complications and deaths. Conclusion: Traumatic hepatic hemorrhage along the needle puncture tract is a common accompanying condition during liver biopsy. Immediate postoperative color Doppler ultrasonography can trace bleeding signals in timely manner and direct effective compression hemostasis, so it should be used routinely to help avoid occurrence of severe hemorrhagic complications.

Analysis on depression state outcomes and influencing factors of persistent depression in pregnant and perinatal women in China / 中华流行病学杂志

Objective: To investigate the depression status of pregnant and perinatal women in early, medium-term, late pregnancy and postpartum period in China and the outcomes of depression in each period, analyze the influential factors of depression status. Methods: By using the pregnant and perinatal women mental health cohort established by National Center for Women and Children's Health of Chinese Center for Disease Control and Prevention, Haidian District Maternal and Child Health Hospital of Beijing, Women Health Center of Shanxi, Jilin Women and Children Health Hospital, Zhuhai Center for Maternal and Child Health Care and Shenzhen Maternity and Child Healthcare Hospital of Guangdong province, a follow up study was conducted at 7 time points during pregnancy and perinatal period in pregnant and perinatal women in Beijing, Shanxi, Jilin and Guangdong from August 1, 2015 to October 31, 2016. The self-filled questionnaire and Edinburgh Postpartum Depression Scale (EPDS) were used to obtain the general demographic information and depression status of the pregnant and perinatal women, and the depression status and natural outcomes of the pregnant and perinatal women were analyzed. Results: A total of 1 284 pregnant and perinatal women were recruited. In this study, a total of 1 210 subjects who completed follow-up at least 6 times and postpartum 42 day follow up were included in the final analysis. The EPDS depression score at the gestation week 13 was used to indicate the depression status in early pregnancy, the average EPDS score of gestation week 17 and 24 were used to indicate the depression status in medium-term pregnancy, and the average EPDS score of gestation week 31 and 37 were used to indicate depression in late pregnancy. The average EPDS score of postpartum day 3 and 42 were used to indicate postpartum depression status. A total of 321 (26.5%), 218 (18.0%), 189 (15.6%) and 219 (18.1%) pregnant and perinatal women were found to have depression, respectively, in early, medium-term and late pregnancy and in postpartum period. The depression status in early, medium-term and late pregnancy and postpartum period were positively correlated (P<0.001), the correlation between early and middle pregnancy was strong (r=0.678), the correlation between medium-term and late pregnancy was strong (r=0.771), and the correlation between postpartum period and late pregnancy was strong (r=0.706). Among the pregnant women with depression in early pregnancy, 26.2% were depressed during the whole study period, 42.7% were depressed during postpartum period, and the results of multifactorial analysis showed that the education level of college or above of the pregnant and perinatal women (OR=0.437, 95%CI: 0.212-0.900, P=0.025), exercise during pregnancy (OR=0.586, 95%CI: 0.348-0.987, P = 0.044), high marital satisfaction (OR = 0.370, 95%CI: 0.221-0.620, P<0.001), normal body mass index (BMI) (OR=0.516, 95%CI: 0.270-0.985, P=0.045) reduced the risk for depression. Unsatisfactory living environment (OR=1.807, 95%CI: 1.074-3.040, P=0.026) increased the risk for depression. Conclusions: In pregnant and perinatal women in China, the detection rate of depression in early pregnancy was highest compared with those in medium-term and late pregnancy. The detection rate of depression increased again in postpartum period. The depression status detected in the early pregnancy remained in the medium-term and late pregnancy and postpartum period. Exercise, BMI, educational level, living environment satisfaction and marital satisfaction can affect the incidence of depression in pregnant and perinatal women.

Progress of miR-196 in the development and diagnosis of non-small cell lung cancer / 国际外科学杂志

Microribonucleic acid (miRNAs) is a widely existing endogenous single-stranded non-coding small RNA, which is stably expressed in tissues and body fluids. By complementing messenger RNA(mRNA) sequences, miRNAs degrade target mRNA and block the expression of protein-coding genes, playing a key role in post-transcriptional regulation and different biological processes. In recent years, more and more studies have shown that miRNAs are closely related to the occurrence and development of tumors. Among them, as a member of the miRNAs family, microribonucleic acid-196 (miR-196) is abnormally expressed in the serum, tissues and cells of patients with non-small cell lung cancer, participating in the occurrence and development of non-small cell lung cancer and playing an important regulatory role in various biological processes such as proliferation, invasion and metastasis, providing diagnostic evidence for early screening of non-small cell lung cancer.This paper reviews the progress of miR-196 in the development and diagnosis of non-small cell lung cancer.

Biological characteristics and functions of glutathione cytoplasmic degrading enzyme ChaC1 / 中国生物化学与分子生物学报

Glutathione is a tri-peptide that plays key roles in antioxidation and detoxification. At present, research on glutathione metabolism mainly focuses on anabolism. And little is known about its catabolismin the cytoplasm. With the discovery of glutathione-specific γ-glutamylcyclotransferase ChaC1, thecatabolism of glutathione in the cytoplasm has gradually been unveiled. ChaC1 is one member of the γ-glutamylcyclotransferase (GGCT) family, catalyzing the degradation of glutathione and production of Cys-Gly and 5-oxoproline. ChaC1 is highly conserved, with a ~ 88% identity between human and mousegenes. Mutation of E115 in human ChaC1 or E116 in mouse ChaC1 abolishes its enzymatic activity. Notably, ChaC1 deficiency leads to embryonic lethality in the mouse and zebrafish, indicating ChaC1 isessential for embryo development. On the other side, ChaC1 is highly expressed in different types ofcancer and correlates with a poor prognosis, suggesting that ChaC1 also has important pathophysiologicalfunction. In this paper, we review the research progress on the structure, enzymatic activity andexpression pattern of ChaC1 in recent years, and summarize the role of ChaC1 in development anddiseases, providing new insights on the mechanisms and therapeutic strategies.

Mumps antibody levels after MMR vaccination in a population in Changning District of Shanghai / 上海预防医学

ObjectiveTo evaluate the dosage effect of measles， mumps and rubella combined attenuated live vaccine （MMR） vaccination on seroprevalence of mumps. MethodsA cross-sectional study was conducted among people in Changning District of Shanghai aged 1 month to 19 years old （n=1 816） in Mar.－Sep. 2017. Blood samples were analyzed for mumps antibodies using enzyme-linked immunosorbent immunoglobulin G （IgG） assays. ResultsMumps antibody seropositivity was 94.59% in 2 years old children and maintained at 98.18%-100.00% from 4 to 9 years old. The seropositivity began to decrease since 10 years， and it was 88.33% （95%CI： 81.20%-93.47%） at age of 12 years. In 12-19 years age group， individuals with 3 doses of mumps-containing vaccines had the highest seropositivity （93.88%） and individuals with 1 or 0 doses had the lowest seropositivity （68.75%）. ConclusionTwo-dose MMR immunization in Shanghai induces a sharp increase in mumps antibody levels in the corresponding age groups. The antibody levels decline gradually with time since the second dose. Vaccine dosage is positively associated with mumps IgG seropositivity and geometric mean concentrations （GMC） in 12-19 years old.

Mumps antibody levels after MMR vaccination in a population in Changning District of Shanghai / 上海预防医学

ObjectiveTo evaluate the dosage effect of measles， mumps and rubella combined attenuated live vaccine （MMR） vaccination on seroprevalence of mumps. MethodsA cross-sectional study was conducted among people in Changning District of Shanghai aged 1 month to 19 years old （n=1 816） in Mar.－Sep. 2017. Blood samples were analyzed for mumps antibodies using enzyme-linked immunosorbent immunoglobulin G （IgG） assays. ResultsMumps antibody seropositivity was 94.59% in 2 years old children and maintained at 98.18%-100.00% from 4 to 9 years old. The seropositivity began to decrease since 10 years， and it was 88.33% （95%CI： 81.20%-93.47%） at age of 12 years. In 12-19 years age group， individuals with 3 doses of mumps-containing vaccines had the highest seropositivity （93.88%） and individuals with 1 or 0 doses had the lowest seropositivity （68.75%）. ConclusionTwo-dose MMR immunization in Shanghai induces a sharp increase in mumps antibody levels in the corresponding age groups. The antibody levels decline gradually with time since the second dose. Vaccine dosage is positively associated with mumps IgG seropositivity and geometric mean concentrations （GMC） in 12-19 years old.

Effect of long-term alcohol intake on field potential of cerebellar granule layer in mice and its mechanism / 中华行为医学与脑科学杂志

Objective:To investigate the effect of long-term alcohol intake on sensory information synaptic transmission of mossy fiber-granular cells in the cerebellar cortex of mice.Methods:Twenty healthy male ICR mice aged 6 to 8 weeks were divided into normal saline group(control group) and alcohol intake group(alcohol group) according to random number table, with 10 mice in each group. The mice in alcohol group were injected intraperitoneally with 20% alcohol and the mice in control group were injected with the same amount of saline for 28 days.After the injection, the scalp, muscle tissue and skull were removed in turn, and the dura mater was removed to fully expose the crus II area of cerebellum. The mice were stimulated by air blowing at 30 mm of the ipsilateral tentacle pad with a gas jet device.When the the maximal response site was determined, the NMDA receptor antagonist (D-APV), metabolic glutamate receptor 1 antagonist (JNJ16259685) and N-methyl-D-aspartic acid (NMDA) were perfused on the brain surface of mice. Each drug was perfused for 20 minutes and ACSF was used between the two drugs until the waveform was recovered. Patch clamp amplifier was used to record the changes of potential waveform in mouse cerebellar granule layer. The data were analyzed by the softwares of Clampfit 10.3 and SPSS 22.0.Results:After exposure to wind stimulation, the latency of field potential response in granular layer of mice in alcohol group (11.8±0.7)ms was significantly longer than that in the control group (10.1±0.2)ms ( t=-8.041, P<0.05), and the amplitude of N1 (1.2±0.1) MV was significantly lower than that in the control group (0.6±0.1) MV ( t=-12.728, P<0.05). Compared with the control group, the rise time of P1 waveform((4.4±0.2)ms, (3.2±0.2)ms), duration ((12.1±0.5)ms, (10.3±0.2)ms), extinction time((7.8±0.2)ms, (6.9± 0.2)ms), volume under waveform ((7.3±0.2)ms, (4.3±0.2)ms) were significantly increased in the alcohol group ( t=16.100, - 11.840, -11.673, -35.576, all P<0.05). There were no significant differences in the amplitude, half width, rise time and decay time of Roff wave between the two groups ( t=-1.909, -0.910, -0.789, 1.462, all P>0.05). When JNJ16259685 was perfused on the brain surface of mice in alcohol group, the amplitude of field potential evoked by five blowing stimuli had no significant difference compared with that before administration (all P>0.05). When D-APV was perfused into the brain surface of mice in the alcohol group, the amplitude of P1 ((42.3±1.5) Mv)was significantly lower than that before administration ((101.1±0.9)mV) and after elution ((100.1±2.2) mV) ( t=106.762, - 69.605, both P<0.05), and the area under waveform of P1 ((42.6±1.3)%) was also significantly lower than that before administration ((100.6±1.6)%) and after elution ((97.6±2.2)%) ( t=88.862, -67.791, both P<0.05).The ratio of N2 / N1 (0.3±0.1) was significantly lower than that before administration (0.4±0.1) and after elution (0.3±0.1) ( t=2.242, 2.121, both P<0.05). When NMDA was perfused on the brain surface of mice in the control group, compared with before administration and after elution, the amplitude of P1 ((110.7±3.2) mV, (100.1±0.9) mV, (102.0±1.7) mV, t=-10.173, 7.669, both P<0.05), the area under the waveform of P1 ((127.9±3.5)%, (100.0±3.1)%, (115.0±5.3)%, t=-18.698, 6.447, both P<0.05), the ratio of N2 / N1 ((0.5±0.1), (0.3±0.1), (0.3±0.1), t=-5.669, 5.669, both P<0.05) were all significantly increased. When D-APV was perfused on the brain surface of mice in control group, the field potential evoked by blowing stimuli had no significant difference compared with that before administration and after elution (all P>0.05). Conclusion:Long-term alcohol intake significantly suppresses the synaptic transmission of excitatory glutamate in MF-GC, and enhances the inhibitory response mediated by GABAA receptor in cerebellar cortex. The inhibitory component is enhanced by NMDA receptor, but not by type 1 metabolic glutamate receptor.

Correlation between estrogen and progesterone fluctuation and expression of extrasynaptic δ-subunits containing γ-aminobutyric acid type A receptors in cortex and hippocampus during estrous cycle in mice / 解剖学报

Objective To explore the correlation of progesterone and expression of extrasynaptic δ-subunits containing γ-aminobutyric acid type A receptors (δGABA

Research advances in liver failure associated with hepatitis B virus reactivation / 临床肝胆病杂志

Hepatitis B virus (HBV) infection is a major public issue in the world. Although currently used antiviral drugs can effectively control virus replication, they cannot clear HBV and HBV reactivation is still observed after the withdrawal of anti-HBV drugs. Meanwhile, experimental studies and clinical research have shown that after HBV infection, although 95% of the adult patients can achieve clinical cure spontaneously, virus genome still exists in host hepatocytes, and when immunosuppressants or chemotherapeutic drugs are used for the treatment of underlying diseases such as solid tumor, hematological malignancies, rheumatic immune diseases, and HCV infection, HBV replication might be reactivated. HBV reactivation may lead to severe clinical outcomes, and some patients may experience liver failure or even death. Retrospective studies in China show that 9%-30% of the cases of acute-on-chronic hepatitis B liver failure are caused by HBV reactivation, and therefore, it is of great importance to identify the population at risk of HBV reactivation and develop reasonable preventive measures, which may help to reduce the development of acute-on-chronic hepatitis B liver failure. This article reviews the definition and basis of HBV reactivation, elaborates on the predisposing factors and mechanism of HBV reactivation in inducing liver failure, and summarizes the population requiring prevention and related preventive measures.

Value of Elastography Strain Ratio Combined with Breast Ultrasound Imaging Reporting and Data System in the Diagnosis of Breast Nodules / 中国医学科学院学报

Objective To explore the value of elastography strain ratio(SR)combined with breast ultrasound imaging reporting and data system(BI-RADS-US)in the differential diagnosis of breast nodules.Methods A total of 471 breast nodules(from 471 patients)were reclassified by SR combined with BI-RADS-US.With the pathology results as gold standard,the area under the receiver operating characteristic(ROC)curve(AUC)was employed to evaluate the diagnostic performance,and the sensitivity,specificity,and accuracy were compared between the combined method and BI-RADS-US.Results Among the 471 breast nodules,180 nodules were benign and 291 were malignant.The AUC of the combined method was statistically significantly higher than that of BI-RADS-US(0.798 vs. 0.730;Z= 2.583, P= 0.010).SR,BI-RADS-US,and the combined method for diagnosing breast nodules had the sensitivity of 86.6%,99.0%,and 96.6%,the specificity of 67.2%,47.2%,and 63.3%,and the accuracy of 79.2%,79.2%,and 83.9%,respectively.The combined method increased the specificity from 47.2%(BI-RADS-US)to 63.3%(χ

Humphrey custom program for driver's license verification to evaluate visual field of unilateral visual impaired applicants / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate visual field of the unilateral visually impaired applicants by a custom program test of Humphrey perimeter, which was indispensable for car driving.<p>METHODS: A retrospective study was performed. The process of a custom defined Humphrey ‘1 EYE Screening' program was set covers field region from temporal 90° to nasal 60°, and over 30° vertically away from the horizontal line. The candidates were qualified eligibility by range of visual field and reliability of the results. This study conducted statistics on the applicants who fulfilled the test from July 1st, 2016 to June 30th, 2017, and compared the impact factors of the pass rate.<p>RESULTS: After excluding repeated measurement reports, this study included 618 subjects, the most common causes of these eyes impaired were ocular trauma(49.7%)and unhealed amblyopia(29.3%). A total of 497 candidates(80.4%)passed the test. 85 of the 121 failure cases(70.2%)were due to a limitation of the nasal visual field(less than 60°), and 12 cases were failed by fixation loss because of nystagmus or poor cooperation. Compared with the test failure group, the subjects in the passing group are older, the average correct response points is more, and the average test time is shorter, all with statistically significant differences(<i>P</i><0.05). In the passing group, the proportion of subjects with equivalent spherical mirror <0.5D was 77.5%, which was significantly higher than 62.8% in the failure group(χ2=7.264, <i>P</i>=0.007).<p>CONCLUSION: The custom program ‘1 EYE Screening' of Humphrey perimetry can be used to qualify eligibility of driving for unilateral visual impaired applicants. In order to prevent peripheral interfering from eye frames, corneal contact lenses were recommended for applicants with refractive errors.

Clinical comparison study of VATS anterior mediastinal tumor resection through approach of trans-subsagittal incision and trans-intercostal incision / 中华胸心血管外科杂志

Objective:To compare the clinical effect of anterior mediastinal tumor resection with video assisted thoracoscopic surgery(VATS) through approach of trans-subsagittal incision and trans-intercostal incision.Methods:The clinical data of 118 patients including 67 males and 51 females with anterior mediastinal tumors using VATS resection from January 2013 to October 2020 in Tongren Hospital, Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. According to different incisional approach, these patients were divided into two groups of trans-subsagittal incision group including 45 cases with 25 males and 20 females, and trans-intercostal incision group including 73 cases with 42 males and 31 females. The sternal incision group was treated with the sub xiphoid incision plus the subcostal arch incision and the sternal retractor traction sternum, and the intercostal incision group was treated with the traditional intercostal space incision. Subsagittal incision combined subcostal arch incision and sternum traction with sternal retractor was used in the approach of trans-subsagittal incision group, and the traditional thoracotomy was used in the intercostal incision group. The clinical data of operation time, volume of intraoperative blood loss, rate of transfer to open thoracotomy, duration of postoperative chest tube drainage, visual analogy score(VAS)assessed on the 1st and 3rd days after surgery, hospitalization time, average cost of hospitalization, and incidence of postoperative complications, were compared between the two groups.Results:The operative time, volume of intraoperative blood loss, the number of cases of transfer to open thoracotomy, duration of postoperative chest tube drainage, VAS score of the first and third days after operation, length of hospitalization, average hospitalization cost and the incidence of postoperative complications were lower than those in the transcostal incision group( P<0.05). Conclusion:Compared to the group of trans-intercostal incision VATS resection of anterior mediastinal tumor, the trans-subsagittal incision group has many advantages as follows, shorter operation time, less intraoperative blood loss, no transfer to open thoracotomy, much simpler and safer operative procedure, less body trauma, lighter postoperative pain, less postoperation complications, shorter hospitalization time, less average hospitalization cost, and rapid rehabilitation after surgery.

Treatment of systemic immunoglobulin light chain amyloidosis / 中华皮肤科杂志

Systemic immunoglobulin light chain amyloidosis is a protein-misfolding disease caused by the highly organized amyloid fibrillar aggregates that lead to irreversible organ dysfunction. This review summarizes systemic therapies for this disease according to the disease risk stratification. Patients with low-risk systemic immunoglobulin light chain amyloidosis are eligible for chemotherapy combined with autologous hematopoietic stem cell transplantation. Patients with high-risk systemic immunoglobulin light chain amyloidosis can be treated with protease inhibitors (such as bortezomib, carfilzomib and ixazomib) , immunomodulatory agents (such as lenalidomide, pomalidomide) and new immunological agents (such as daratumumab and NEOD001) .

Guidance on the use of biologic agents in psoriatic patients during COVID-19 outbreak / 中华皮肤科杂志

The COVID-19 outbreak may have some impact on the use of biologics in psoriatic patients because immunosuppressive effects of biologics may potentially alter the susceptibility of patients to the virus, deteriorate the condition of infected patients or even change the prognosis of infection. According to currently available recommendations from international psoriasis academic organizations and specialists, as well as specific situation in China, the authors provide some guidance on the use of biologics for psoriatic patients undergoing or planning to undergo treatment with biologics, those with low or high risk of infection, and for those with or without COVID-19 infection, so as to provide references for clinical practice.

Correlation between apoptosis rate and expression of Bcl-2, Bax and tumor necrosis factor alpha in diabetic foot ulcer with different disease courses / 中国组织工程研究

BACKGROUND: Non-healing of refractory ulcer wounds is found to be associated with imbalance of apoptosis and dysregulation of inflammation. Previous studies have sampled a certain type of tissue in different individuals, but individual differences maybe exist among the study data. There is still no report on the correlation between apoptotic rate, expression levels of Bcl-2, Bax, Bax/Bcl-2 and tumor necrosis factor α (TNF-α) in wound tissue of diabetic foot ulcer with different disease courses. OBJECTIVE: To study the relationship between apoptotic rate and expression levels of Bcl-2, Bax and TNF-α in the wound tissue of diabetic foot ulcer with different disease courses and the mechanism of action. METHODS: Fifteen patients with typical diabetic foot of Wagner grades 2-3 were selected from the Department of Emergency, Chongqing Medical University. The wound tissue was classified as necrotic, transitional and normal tissue using the "4C” method after infection control. The apoptotic rate and levels of Bcl-2, Bax, TNF-α and Bax/Bcl-2 were detected using immunohistochemistry, and the results were statistically analyzed. The study protocol was approved by the Ethics Committee of the Second Affiliated Hospital of Chongqing Medical University, with the approval No. (2019)329. All patients signed an informed consent. RESULTS AND CONCLUSION: The apoptotic rates of normal, transitional and necrotic tissues of diabetic foot were significantly different, which were (16.67±2.48)%, (43.68±2.22)% and (72.12±4.53)%, respectively (P transitional tissue > normal tissue. There was a curve relationship between Bcl-2, Bax, Bax/Bcl-2, TNF-α expression and apoptotic rate. The curvilinear regression analysis indicated that the expression of TNF-α had a highly positive correlation with the expression of Bax and Bax/Bcl-2 and had a highly negative correlation with the expression of Bcl-2. Therefore, apoptotic mechanism and inflammatory reaction are involved in the pathological process of diabetic food ulcer, and the mechanism may be related to the down-regulation of Bcl-2 expression, up-regulation of Bax and TNF-α expression, and increase of Bax/Bcl-2, thereby increasing the apoptotic rate.

New Model of Traditional Chinese Medicine with Effect of Invigorating Kidney and Filling Sea of Marrow in Regulating Delay in Cortical Maturation of ADHD Based on Theory of Steady Yin and Vexed Yang / 中国实验方剂学杂志

Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder among children. The theory of traditional Chinese medicine (TCM) does not have a special term of this disease, and classifies ADHD to the category of " forgetfulness" " dysphoria" " injudiciousness" according to its clinical manifestations. TCM theoretic and clinical systems for treating ADHD have been developed, but current pharmacodynamics studies of TCM on ADHD have mostly focused on neurotransmitter metabolic system and its receptor signaling pathway to reflect the advantages of multi-component and multi-target effect of TCM, but failed to demonstrate the scientific connotations of TCM theory, such as " coordination between kidney and brain" and " steady Yin and vexed Yang" , and ignored the delay in cortical maturation as the core neuropathology of ADHD. The symptoms relating to " restlessness of Yang" due to Yin deficiency that cannot inhibit hyperactivity of Yang, kidney-Yin deficiency and liver-Yang excess syndrome is the most common syndrome of ADHD, and TCMs with effect of invigorating kidney and filling sea of marrow are mostly used by TCM practitioners. According to anatomy basis of neuronal development disorder, the new theory of " energy metabolism dysfunction" , the pathogenesis hypothesis of sea of marrow development disorder and its relevant clinical practices and experimental studies, substantial basis studies of the therapy for " invigorating kidney and filling sea of marrow" , as well as pharmacodynamics study of <italic>Rehmannia glutinosa</italic> (Shudihuang) for treating ADHD, we put forward ADHD pathogenesis that " restlessness of Yang due to Yin deficiency" is related to the disorder of executive function due to the delay in cortical maturation, energy metabolism dysfunction and neurodevelopmental disorder, and regarded that TCMs with effect of invigorating kidney and filling sea of marrow are the most commonly used to treat ADHD, and improve delay in cortical maturation corresponding to sea of marrow insufficiency by regulating dysfunction of neurodevelopment and energy metabolism, so as to relieve the core symptoms of ADHD. The new treatment model of TCM with effect of invigorating kidney and filling sea of marrow for treating ADHD will provide a theoretical basis for improving the clinical efficacy of ADHD.