Research progress of CRISPR/Cas biosensors based on different signal amplification strategies / 中华预防医学杂志

CRISPR/Cas(the clustered regularly interspaced short palindromic repeats-CRISPR associated)system exists in most bacteria and all archaea. It is an important strategy for bacteria and archaea to resist foreign nucleic acid invasion and use for self-defense. The CRISPR/Cas system is a simple, fast, and specific diagnostic tool, which is widely used in agriculture, industry, animal husbandry, and medicine. This article mainly introduces and discusses recently advantages and limitations of biosensors combining CRISPR/Cas system with fluorescence, visualization and surface enhanced raman related technologies, as well as future research directions.

Long-Term Prognosis of Different Reperfusion Strategies for ST-Segment Elevation Myocardial Infarction in Chinese County-Level Hospitals: Insight from China Acute Myocardial Infarction Registry / 生物医学与环境科学（英文）

OBJECTIVE@#To evaluate the long-term prognosis of patients with ST-segment elevation myocardial infarction (STEMI) treated with different reperfusion strategies in Chinese county-level hospitals.@*METHODS@#A total of 2,514 patients with STEMI from 32 hospitals participated in the China Acute Myocardial Infarction registry between January 2013 and September 2014. The success of fibrinolysis was assessed according to indirect measures of vascular recanalization. The primary outcome was 2-year mortality.@*RESULTS@#Reperfusion therapy was used in 1,080 patients (42.9%): fibrinolysis ( n= 664, 61.5%) and primary percutaneous coronary intervention (PCI) ( n= 416, 38.5%). The most common reason for missing reperfusion therapy was a prehospital delay > 12 h (43%). Fibrinolysis [14.5%, hazard ratio ( HR): 0.59, 95% confidence interval ( CI) 0.44-0.80] and primary PCI (6.8%, HR= 0.32, 95% CI: 0.22-0.48) were associated with lower 2-year mortality than those with no reperfusion (28.5%). Among fibrinolysis-treated patients, 510 (76.8%) achieved successful clinical reperfusion; only 17.0% of those with failed fibrinolysis underwent rescue PCI. There was no difference in 2-year mortality between successful fibrinolysis and primary PCI (8.8% vs. 6.8%, HR = 1.53, 95% CI: 0.85-2.73). Failed fibrinolysis predicted a similar mortality (33.1%) to no reperfusion (33.1% vs. 28.5%, HR= 1.30, 95% CI: 0.93-1.81).@*CONCLUSION@#In Chinese county-level hospitals, only approximately 2/5 of patients with STEMI underwent reperfusion therapy, largely due to prehospital delay. Approximately 30% of patients with failed fibrinolysis and no reperfusion therapy did not survive at 2 years. Quality improvement initiativesare warranted, especially in public health education and fast referral for mechanical revascularization in cases of failed fibrinolysis.

Clinicopathological and prognostic features of subungual melanoma in situ / 中华病理学杂志

Objective: To investigate the clinicopathological characteristics, immunohistochemical profiles, molecular features, and prognosis of subungual melanoma in situ (SMIS). Methods: Thirty cases of SMIS were collected in Fudan University Shanghai Cancer Center, Shanghai, China from 2018 to 2022. The clinicopathological characteristics and follow-up data were retrospectively analyzed. Histopathologic evaluation and immunohistochemical studies were carried out. By using Vysis melanoma fluorescence in situ hybridization (FISH) probe kit, combined with 9p21(CDKN2A) and 8q24(MYC) assays were performed. Results: There were 8 males and 22 females. The patients' ages ranged from 22 to 65 years (median 48 years). All patients presented with longitudinal melanonychia involving a single digit. Thumb was the most commonly affected digit (16/30, 53.3%). 56.7% (17/30) of the cases presented with Hutchinson's sign. Microscopically, melanocytes proliferated along the dermo-epithelial junction. Hyperchromatism and nuclear pleomorphism were two of the most common histological features. The melanocyte count ranged from 30 to 185. Most cases showed small to medium nuclear enlargement (29/30, 96.7%). Pagetoid spread was seen in all cases. Intra-epithelial mitoses were identified in 56.7% (17/30) of the cases. Involvement of nailfold was found in 19 cases, 4 of which were accompanied by cutaneous adnexal extension. The positive rates of SOX10, PNL2, Melan A, HMB45, S-100, and PRAME were 100.0%, 100.0%, 96.0%, 95.0%, 76.9%, and 83.3%, respectively. FISH analysis was positive in 6/9 of the cases. Follow-up data were available in 28 patients, and all of them were alive without disease. Conclusions: SMIS mainly shows small to medium-sized cells. High melanocyte count, hyperchromatism, nuclear pleomorphism, Pagetoid spreading, intra-epithelial mitosis, nailfold involvement, and cutaneous adnexal extension are important diagnostic hallmarks. Immunohistochemistry including SOX10 and PRAME, combined with FISH analysis, is valuable for the diagnosis of SMIS.

Application of four-valve technique in the improved conjunctivo-dacryocystorhinostomy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the safety and effectiveness of four-valve technique in the improved conjunctivo-dacryocystorhinostomy. METHODS: Retrospective clinical study. A total of 28 patients(28 eyes)who were treated in our hospital from September 2017 to June 2020 with lacrimal disease were selected as the research subjects. These patients were treated with conjunctivo-dacryocystorhinostomy. Postoperative follow-up was performed for 6-12mo to observe the surgical effect, satisfaction and postoperative complications.RESULTS: The positive rate of fluorescein sodium dye excretion test after surgery in this group of patients was 96%(27/28), the success rate of surgery was 96%(27/28), the cure rate was 68%(19/28), the improvement rate was 28%(8/28), the ineffective rate was 4%(1/28)and the overall satisfaction of patients was 93%(26/28). The postoperative complications included ocular foreign body sensation(28 eyes), conjunctival hyperemia(11 eyes), nasal cavity and conjunctival sac bleeding(8 eyes)and lacrimal passage tube out(1 eye). CONCLUSION: The four-valve technique is used to improve the conjunctivo-dacryocystorhinostomy with high success rate, less complications, safety and effectiveness.

Establishment of an in vitro screening model for uranium decorporation chelators based on the competitive ELISA method / 药学学报

Uranium [U(Ⅵ)] in the blood is known to form stable complexes with apotransferrin (apo-Tf), which plays an important role in mediating the cytotoxicity induced by U(Ⅵ) transported to cells. The present study aimed to establish an new in vitro screening model of U(Ⅵ) decorporation agents through exploring the capability of chelating agents competing with U(Ⅵ) binding to apo-transferrin based on enzyme-linked immunosorbent assay (ELISA). The optimal concentrations of apo-Tf coated antigen, Tf antibody, secondary antibody and U(Ⅵ) treatment were achieved and the stability and reproducibility of this method were validated by methodology study. Using this model, the ability of four chelating agents to mobilize the U(Ⅵ) binding to apo-Tf was evaluated, and the rank of competitiveness was catechol-3,6-bis(methyleiminodiacetic acid） (CBMIDA) ≈ Tiron > apo-Tf > DTPA-CaNa3 ≈ DTPA-ZnNa3. The efficacy of these chelating agents in removal of U(Ⅵ) was tested by animal experiments. The results showed that immediate administration of CBMIDA or Tiron after injection of U(Ⅵ) in mice significantly promoted urinary U(Ⅵ) excretion and reduced U(Ⅵ) accumulation in kidneys and femurs, while DTPA-CaNa3 and DTPA-ZnNa3 have no obvious effects as compared to U(Ⅵ)-exposed mice alone, which was consistent with the results of competitive ELISA method. The animal experiments conform to the rules of the Animal Research Ethics Committee of School of Pharmacy of Fudan University. These results show that the new proposed method is rapid, simple and convenient with good reproducibility and has the potential to be used for in vitro screening of U(Ⅵ) decorporation agents.

Effect of Metallic Arraymicroneedle Pretreatment on Ramosetron Hydrochloride Paches in Transdermal Drug Delivery / 中国药学杂志

OBJECTIVE: To evaluate the effects of different pretreatment ways on microneedle onits penetration enhancing effect for ramosetron hydrochloride paches in microneedle-assisted transdermal drug delivery. METHODS: Skin penetration experiments were carried out using excised guinea pig skin. Microneedle pretreatment ways including needle type, needle length, needle acting force and acting time were taken as the influencing factors. The main effects and interaction effects of influencing factors in skin penetration enhancement were analyzed. RESULTS: Microneedle length had the most significant impact on drug skin penetration. When the length changed from 200 μm to 300 μm, the steady-state permeation rate and the cumulative permeation amount within 48 h displayed marked increase. Additionally, there was interaction between the penetration enhancing effects of the microneedle length and acting force. When the acting time and needle type were fixed and the microneedle length was 200 μm, no significantly different impacts occurred if the acting force varied between 3 and 5 N. However, if the microneedle length was 300 μm, the penetration enhancing effects became more significant when increasing acting force from 3 to 5 N. CONCLUSION: This studies suggeste that microneedle pretreatment ways may result in different effects on penetration of drugs through skin, and there may exist interaction effect between different microneedle pretreatment ways.This study provides a reference for the selection of microneedle pretreatment in microneedle-assisted transdermal drug delivery.

Study on prevalence and vertical transmission rate of Toxoplasma gondii infections among parturient women in Wuhu City / 中国血吸虫病防治杂志

Objective To investigate the prevalence and vertical transmission rate of Toxoplasma gondii infections among in parturient women in Wuhu City, so as to provide reference for the prevention and control of toxoplasmosis among pregnant women in the city. Methods Parturient women’s venous blood samples and neonatal heel blood samples were collected in Wuhu City and prepared into filter-paper blood samples. The prevalence and vertical transmission rate of T. gondii infections were detected using the loop -mediated isothermal amplification (LAMP) assay among the parturient women. Results There were three positive samples detected in the 475 filter-paper blood samples from the parturient women, with a mean positive rate of 0.63%. The prevalence of T. gondii infection was 0 in pregnant women at ages of < 20 years (0/5) and at an advanced maternal age (0/24), while the prevalence was 0.67% (3/446) in pregnant women at an appropriate maternal age. T. gondii infection was detected in 2 filter-paper blood samples from newborns, with a vertical transmission rate of 66.67%. Conclusions There is T. gondii infection in the parturient women and a high vertical transmission rate of T. gondii infection is detected in Wuhu City. The awareness of the potential risk factors of toxoplasmosis should be improved among pregnant women to prevent the damages of toxoplasmosis to humans.

Study on prevalence and vertical transmission rate of Toxoplasma gondii infections among parturient women in Wuhu City / 中国血吸虫病防治杂志

Objective To investigate the prevalence and vertical transmission rate of Toxoplasma gondii infections among in parturient women in Wuhu City, so as to provide reference for the prevention and control of toxoplasmosis among pregnant women in the city. Methods Parturient women’s venous blood samples and neonatal heel blood samples were collected in Wuhu City and prepared into filter-paper blood samples. The prevalence and vertical transmission rate of T. gondii infections were detected using the loop -mediated isothermal amplification (LAMP) assay among the parturient women. Results There were three positive samples detected in the 475 filter-paper blood samples from the parturient women, with a mean positive rate of 0.63%. The prevalence of T. gondii infection was 0 in pregnant women at ages of < 20 years (0/5) and at an advanced maternal age (0/24), while the prevalence was 0.67% (3/446) in pregnant women at an appropriate maternal age. T. gondii infection was detected in 2 filter-paper blood samples from newborns, with a vertical transmission rate of 66.67%. Conclusions There is T. gondii infection in the parturient women and a high vertical transmission rate of T. gondii infection is detected in Wuhu City. The awareness of the potential risk factors of toxoplasmosis should be improved among pregnant women to prevent the damages of toxoplasmosis to humans.

Next-generation Sequencing Study of Pathogens in Serum from Patients with Febrile Jaundice in Sierra Leone / 生物医学与环境科学（英文）

OBJECTIVE@#People in Western Africa suffer greatly from febrile jaundice, which is caused by a variety of pathogens. However, yellow fever virus (YFV) is the only pathogen under surveillance in Sierra Leone owing to the undeveloped medical and public health system there. Most of the results of YFV identification are negative. Elucidation of the pathogen spectrum is required to reduce the prevalence of febrile jaundice.@*METHODS@#In the present study, we used Ion Torrent semiconductor sequencing to profile the pathogen spectrum in archived YFV-negative sera from 96 patients in Sierra Leone who presented with unexplained febrile jaundice.@*RESULTS@#The most frequently identified sequencing reads belonged to the following pathogens: cytomegalovirus (89.58%), Epstein-Barr virus (55.21%), hepatitis C virus (34.38%), rhinovirus (28.13%), hepatitis A virus (20.83%), coxsackievirus (10.42%), Ebola virus (8.33%), hepatitis E virus (8.33%), lyssavirus (4.17%), leptospirosis (4.17%), chikungunya virus (2.08%), Crimean-Congo hemorrhagic fever virus (1.04%), and hepatitis B virus (1.04%).@*CONCLUSION@#The distribution of sequencing reads suggests a broader spectrum of pathogens for consideration in clinical diagnostics and epidemiological surveillance in Sierra Leone.

Predictive Value of PARIS Bleeding Score on In-hospital Bleeding of Acute Myocardial Infarction Patients With Drug-eluting Stent Implantation / 中国循环杂志

Objective: To evaluate the predictive value of PARIS bleeding score on in-hospital bleeding of acute myocardial infarction (AMI) patients after drug-eluting stent (DES) implantation with dual-antiplatelet therapy (DAPT). Methods: There were 27 594 AMI patients enrolled in China acute myocardial infarction (CAMI) registry between 2013-01-01 to 2014-09-30 from 107 hospitals, and 14 625 of them had successful in-hospital DES implantation with DAPT were studied. Based on BARC (bleeding academic research consortium definition) criteria, the end point major bleeding (MB) events were defined by both BARC type 3, 5 and BARC type 2, 3, 5; the incidence of in-hospital bleeding, clinical features and predictive value of PARIS bleeding score according to different BARC type were evaluated. Results: Compared with non-MB patients, MB patients had the higher PARIS bleeding score, P<0.001. Based on PARIS score risk stratification, taking BARC type 3, 5 as endpoint, 77/14 625 (0.53%) patients had bleeding events, PARIS scores were different among high risk, mid risk and low risk patients, P<0.001; bleeding risk in mid risk patients was 2.38 times higher than low risk patients, P=0.006 and bleeding risk in high risk patients was 4.78 times higher than low risk patients, P<0.001.Taking BARC type 2,3,5 as endpoint,223(1.52%)patients had bleeding events,bleeding risk in mid risk patients was 1.64 times higher than low risk patients, P=0.002 and bleeding risk in high risk patients was 2.23 times higher than low risk patients, P=0.001. ROC analysis showed that PARIS score had predictive value on both BARC type 3, 5 and BARC type 2, 3, 5 bleeding, area under curve (AUC) of BARC type 3, 5 (AUC: 0.672) was higher than AUC of BARC type 2, 3, 5 (AUC:0.596) (z=2.079, P=0.038), which implied that PARIS score had better predictive value in severe bleeding events. Conclusion: PARIS bleeding score had predictive value on in-hospital bleeding in AMI patients after DES implantation with DAPT, it can also be used in bleeding risk stratification. PARIS bleeding score had better predictive value on severe bleeding.

Analysis of T2DM to the Serum Nesfatin-1 Level Changes of Patients with NAFLD Horizontal / 现代检验医学杂志

Objective To study the effects of the serum Nesfatin-1 level change by type 2 diabetes in patients with Non-alcoholic fatty liver,and provides a reliable basis for its prysiological effects.Methods Selected 300 cases with type 2 diabetes mellitus in deoartment of endocrinology from January 2014 to January 2016 in Affiliated Hospital of Yan'an University as the object of this study.According to whether the patients were combined with non-alcoholic fatty liver,the patients were divided into T2DM with NAFLD group (150 cases) and T2DM without NAFLD group (150 cases).In addition,150 volunteers for healthy check-up in the hospital were selected as control group.Compared the serum Nesfatin-1 levels of three group patients,and monitored the insulin resistance index of two groups patients with type 2 diabetes.Results BMI,TG,ALT and INS of NGT(23.1±1.9,1.7±0.5,26.9±12.7 and 9.7±2.4,respectively) group and T2DM (22.1±2.5,2.0± 0.9,22.1 ± 10.5 and 11.2± 4.5,respectively) group were significantly lower than those of T2DM-NAFLD group (26.5 ± 3.8,3.0± 2.5,31.9 ± 11.5 and 14.2 ± 6.5;all P value were 0.00).FBG,HbAlc,LDL-C,HOMA-IR and Nesfatin-1 of T2DM group (8.4±3.1,8.8±2.7,3.4±1.0,4.5±2.9 and 6.9±3.0) and T2DM-NAFLD group (8.2±2.7,8.5± 1.9,3.7 ± 2.1,5.2 ± 2.7 and 5.2 ± 2.7) were significantly higher than those in serum NGT group (5.1 ± 0.5,5.4 ± 0.4,2.7 ±0.8,2.7±0.8 and 2.3± 0.7,all P value were 0.00).The serum Nesfatin-1 levels of T2DM patients and patients with T2DM-NAFLD had moderate correlation (r=-0.421,P＜0.05) by Pearson correlation analysis.BMI,TG and serum Nesfatin-1 levels were closely associated with the occurrence of fatty liver (r=-0.402 ～ 0.273;P=0.00 ～ 0.01).Conclusion Nesfatin-1 may be involved in type 2 diabetes mellitus and the occurrence of non-alcoholic fatty liver.

Preliminary optimization of a Chinese herbal medicine formula based on the neuroprotective effects in a rat model of rotenone-induced Parkinson's disease / 中西医结合学报

<p><b>OBJECTIVE</b>The main objective of this study was to preliminarily determine the optimum formulation of a Chinese herbal formula that may have neuroprotective effects against rotenone-induced Parkinson's disease (PD).</p><p><b>METHODS</b>Seven recipes were made from Dihuang (DH, Rehmannia glutinosa Libosch), Roucongrong (RCR, Cistanche deserticola Y.C.Ma), Niuxi (NX, Achyranthes bidentata Bl.) and Shanzhuyu (SZY, Cornus officinalis Sieb. et Zucc) in different proportions, according to the principles of uniform design (4 factors 7 levels). Tyrosine hydroxylase (TH)-positive neurons in substantia nigra pars compacta (SNpc) were detected by immunohistochemistry and rotenone-exposure days necessary to induce PD symptoms were recorded. To probe one likely mechanism of the formulas, echinacoside (ECH) concentrations of all seven recipes were determined by high-performance liquid chromatography and related to number of TH-positive neurons.</p><p><b>RESULTS</b>The data showed that recipe 4 (DH:RCR:SZY:NX = 1:1:1:1) and recipe 7 (DH:RCR:SZY:NX = 7:5:3:1) partially reversed rotenone-induced death of TH-positive neurons in the SNpc and significantly increased rotenone-exposed days compared with model group. Pharmacologically, there was not a strong correlation between ECH concentration and TH-positive neurons.</p><p><b>CONCLUSION</b>The investigated formulations of Chinese herbs had neuroprotective effects against PD models, and the neuroprotective effects were weakly related to the proportion of key herbs. However the neuroprotective effects of the formula may not result from a single active constituent.</p>

Effect of Bone Marrow Mesenchymal Stem Cells in Patients with Multiple Myelima on Migration of Myeloma Cells In Vitro / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To explore the effect of bone marrow mesenchymal stem cells (MSC) in patients with multiple myeloma(MM) on chemotactic migration of myeloma cells in vitro.</p><p><b>METHODS</b>By in vitro co-culture with diffferent MSC, the myeloma cell U266 was divided into 2 groups: group A in which the U266 cells were co-cultured with normal person MSC (N-MSC) and group B in which the U266 cells were co-cultured with MM-MSC. The expression level of CCR1 in U266 cells, migration rate of U266 cells in Transwell, and the effect of supernantant from co-culture of U266 cells with N-MSC and MM-MSC on the migration in Transwell were compared in condition with or without bortezomib.</p><p><b>RESULTS</b>After co-culture of U266 cells with N-MSC or MM-MSC, the migration rate of U266 cells in Transwell in B group was higher than that in A group(P<0.05). The difference between 2 groups could not be eliminated after treatment of U266 cells with bortezomib. The CCR1 expression level of U266 cells in B group was higher than that in A group (P<0.05). The culture supernatant of bone marrow MSC showed that in condition without bortezomib the culture supernatant of MSC in MM patients and normal persons both possessed more strong chemotactic ability and enhanced the migration rate of cells in Transwell, compared with SDF-1, meanswhile the culture supernatant in 3 groups reduced the migration rate of cells in condition with bortezomib (P<0.05), but there were no statistical difference in migration rate of U266 cells in Transwell between supernatant of N-MSC and MM-MSC culture (P>0.05), no matter the bortezonib was used or not.</p><p><b>CONCLUSION</b>The bone marrow MSC in MM patients have same intrinsic defects that affect the chemotaxis of cells in vitro by directly interacting with myeloma cells.</p>

Analysis of Key Issues of Human Resource Allocation and Sharing in Close Medical Alliance / 中国医院管理

68 records from 68 key informant interviews within a sample close medical alliance are analyzed through using content analysis method.Combined with literature review and basic data comparison,the key links and problems are found,and the suggestions of human resource planning,management and incentive mechanism of human resource sharing within close medical associations are put forward.

Effect of Cesarean Section on the Severity of Postpartum Hemorrhage in Chinese Women: The Shanxi Study / 华中科技大学学报（医学）（英德文版）

Postpartum hemorrhage (PPH) is one of the most adverse obstetric outcomes.Our aim is to detect the risks of multilevel PPH in different cesarean section (CS) groups [including nulliparous CS with indications,nulliparous CS without indications,repeat cesarean (RC),vaginal birth after cesarean (VBAC),cesarean after vaginal birth (CAVB)].We conducted a retrospective cohort study,and the data on 127 145 women collected from January 2014 to May 2016 and from 35 tertiary hospitals in Shanxi province,China,were reviewed.Based on the measuring results of PPH,an ordered logistic regression model was used to analyze the adjusted PPH risks for each of the CS groups,and comparisons were drawn between them.Finally,a total of 99 066 nulliparous (77.92％) and 28 079 multiparous (22.08％) women were observed.The number of CS cases was 61 117,and the rate for CS was 48.07％.A total of 10 029 women did not show indications for CS and accounted for 16.41％ of the CS parturient,whereas 9103 women underwent a repeated cesarean,with a CS frequency of 14.89％.The number of VBAC cases was 989,whose rate was 9.88％ in prior CS women.The number (proportions) of PPH was 3658 (2.88％) in LI (PPH volume:≥900 and ＜1500 mL),520 (0.41％) in L2 (PPH volume:≥1500 and＜2100 mL),and 201 (0.16％) in L3 (PPH volume:≥2100 mL).The Ln (n=1,2,3,etc.) represented the increasing order of PPH severity.In the adjusted results,compared with spontaneous vaginal delivery (SVD) as the reference group,in the adjusted result for nulliparous,there was a decreased PPH risk in CS with indications (OR:2.32;CI:2.04-2.62),which was lower than that of CS without indications (OR:2.50;CI:2.01-2.96).The highest PPH risk in all subgroups (i.e.nulliparous and multiparous groups) was observed in the RC (OR:3.61;CI:3.16-4.17),which was nearly twice higher than that of the VBAC (OR:1.82;CI:1.33-2.52).CAVB (OR:1.03;CI:0.65-1.62) showed no significant difference with the reference group.Thus,we deemed that CS should be avoided in nulliparous pregnancies unless indicated,to prevent or reduce the rates for the use of RC or VBAC which are high risks of severe PPH to the parturient women.

Effect of Cesarean Section on the Severity of Postpartum Hemorrhage in Chinese Women: The Shanxi Study / 华中科技大学学报（医学）（英德文版）

Postpartum hemorrhage (PPH) is one of the most adverse obstetric outcomes.Our aim is to detect the risks of multilevel PPH in different cesarean section (CS) groups [including nulliparous CS with indications,nulliparous CS without indications,repeat cesarean (RC),vaginal birth after cesarean (VBAC),cesarean after vaginal birth (CAVB)].We conducted a retrospective cohort study,and the data on 127 145 women collected from January 2014 to May 2016 and from 35 tertiary hospitals in Shanxi province,China,were reviewed.Based on the measuring results of PPH,an ordered logistic regression model was used to analyze the adjusted PPH risks for each of the CS groups,and comparisons were drawn between them.Finally,a total of 99 066 nulliparous (77.92％) and 28 079 multiparous (22.08％) women were observed.The number of CS cases was 61 117,and the rate for CS was 48.07％.A total of 10 029 women did not show indications for CS and accounted for 16.41％ of the CS parturient,whereas 9103 women underwent a repeated cesarean,with a CS frequency of 14.89％.The number of VBAC cases was 989,whose rate was 9.88％ in prior CS women.The number (proportions) of PPH was 3658 (2.88％) in LI (PPH volume:≥900 and ＜1500 mL),520 (0.41％) in L2 (PPH volume:≥1500 and＜2100 mL),and 201 (0.16％) in L3 (PPH volume:≥2100 mL).The Ln (n=1,2,3,etc.) represented the increasing order of PPH severity.In the adjusted results,compared with spontaneous vaginal delivery (SVD) as the reference group,in the adjusted result for nulliparous,there was a decreased PPH risk in CS with indications (OR:2.32;CI:2.04-2.62),which was lower than that of CS without indications (OR:2.50;CI:2.01-2.96).The highest PPH risk in all subgroups (i.e.nulliparous and multiparous groups) was observed in the RC (OR:3.61;CI:3.16-4.17),which was nearly twice higher than that of the VBAC (OR:1.82;CI:1.33-2.52).CAVB (OR:1.03;CI:0.65-1.62) showed no significant difference with the reference group.Thus,we deemed that CS should be avoided in nulliparous pregnancies unless indicated,to prevent or reduce the rates for the use of RC or VBAC which are high risks of severe PPH to the parturient women.

Small cell neuroendocrine carcinoma [SCNEC] of the tongue: a case report

Small cell neuroendocrine carcinoma [SCNEC] of the tongue is very rare. We here present a SCNEC impatient with distant metastasis. A 74-year-old Chinese male went to hospital to treat a tongue tumor, which was founded at a conventional physical examination in weifang stomatology hospital. The check of positron emission tomography-computer tomography [PET-CT] by Weifang people's hospital revealed a tumor in the right root of tongue, and distant metastasis in the right submandibular area, neck, mediastinum, right hilar, abdominal, retroperitoneal multiple lymph nodes, left thyroid, right lower lung, right scapula and bilateral adrenal. The patient was diagnosed tongue SCNEC by the pathological analysis of the tissue section. Conforming to the diagnosis of tongue SCNEC, the patient received adjuvant chemotherapy for 6 cycles with etoposide and carboplatin, and is alive now 9 months after the diagnosis

3D printing of biological materials: progress and clinical application / 中国组织工程研究

BACKGROUND:3D printing, a rapid prototyping technology, is considered to be one of the symbols of the third industrial revolution. There are many kinds of 3D printed materials, which have a wide range of clinical applications.OBJECTIVE: To systematically introduce 3D printed biological materials, to summarize the application advances of 3D printing technology in the printing and production of bone, artificial limbs, dentures, skin, blood vessels, stent, implant prosthesis, and tumor models, as well as to investigate the performance conditions of 3D printed biomaterials based on the advantages and disadvantages of the currently used biomaterials, in order to provide reference for future research.METHODS:A computer-based search of CNKI, Wanfang, VIP, CBM, PubMed was performed to search relevant articles published from 2010 to 2016, using the keywords of three-dimensional printing/3D printing/3-D printing; biomaterials; clinical application in Chinese and English, respectively.RESULTS AND CONCLUSION: Great progress in 3D printed biomaterials has been made. However, there are some defects in the existing printed materials, such as high cost, low printing precision and poor biodegradability. Only if the problem of materials is solved, can we continue to develop 3D printing technology. New breakthroughs in 3D printing in the field of medicine have been made, and new technologies and new materials have been applied in clinical practice. Systemic summarization of these application achievements of 3D printing in the field of medicine can provide reference for future medical research.

Influence of WeChat platform-based continuing nursing on the compliance of antiviral therapy in chronic hepatitis B patients / 中国实用护理杂志

Objective To evaluate the influencing factors of compliance and the compliance changes before and after intervention on chronic hepatitis B patients who oral nucleos(t)ide analogue (NA), by using the continuing care service items provided by WeChat platform. Methods A total of 67 patients with chronic hepatitis B were selected from January 2013 to June 2015. WeChat health care teams and WeChat groups were established to conduct continuing care intervention for 6 months by providing services, such as authoritative scientific diagnosis and treatment information, online consulting service, expert outpatient appointment, etc. Results The score of Morisky Medication Adherence Scale (MMAS-8) in patients of different culture levels of illiteracy (4.75 ± 2.20) points, primary school or junior high school graduate (5.73±1.87) points,high school or vocational school graduate (6.31±1.45) points,university diploma and above (7.24 ± 1.23) points were significant difference (χ2=22.113, P 0.05) both in combination or non-combination. Compared to 6.45 ± 1.69 of pre-intervention, the total compliance score 6.86 ± 1.53 showed significant increased after intervention (Z=-2.551, P < 0.05), and the number of people with high compliance after the intervention increased while the number of people with middle and low compliance after the intervention decreased, and significant differencewas observed in two groups (χ2=9.521, P<0.01). Conclusions After the intervention of continuing care based on WeChat platform, the patients' compliance with nucleoside antiviral drugs were significant improvement than those of pre-intervention.

E670G polymorphism of PCSK9 gene of patients with coronary heart disease among Han population in Hainan and three provinces in the northeast of China

OBJECTIVE@#To investigate the correlation between E670G polymorphism of proprotein convertase subtilisin/kexin type 9 (PCSK9) gene and coronary heart disease (CHD), and contrastively study the regional differences of E670G polymorphism of PCSK9 gene between patients with CHD among the Han population in Hainan and three provinces in the northeast of China (TPNC), providing scientific basis for prevention and treatment of patients with CHD in different regions.@*METHODS@#A total of 233 cases of patients with CHD were selected from the Han population in Hainan and TPNC as the experimental group (118 cases from Hainan, 115 cases from TPNC), and 239 cases with non-CHD were selected among the Han population also in the two regions as control group (125 cases from Hainan, 114 cases from TPNC). The triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol and low density lipoprotein cholesterol (LDL-C) levels of plasma were tested and PCR-RFLP method was used to test the E670G polymorphism of PCSK9 gene. The statistical software package SPSS 21.0 was used for the statistical analysis and P  0.05).@*CONCLUSIONS@#There was a close correlation between the E670G polymorphism of PCSK9 gene and CHD with serum lipid level. Among Han population in Hainan and TPNC, the E670G polymorphism of PCSK9 gene of patients with CHD exhibited regional differences.