A Case Report of Multidisciplinary Diagnosis and Treatment of a Patient with Tuberous Sclerosis Complex and Multi-Organ Involvement / 罕见病研究

Tuberous sclerosis complex(TSC)is a rare genetic disease that can lead to benign dysplasia in multiple organs such as the skin, brain, eyes, oral cavity, heart, lungs, kidneys, liver, and bones. Its main symptoms include epilepsy, intellectual disabilities, skin depigmentation, and facial angiofibromas, whilst incidence is approximately 1 in 10 000 to 1 in 6000 newborns. This case presents a middle-aged woman who initially manifested with epilepsy and nodular depigmentation. Later, she developed a lower abdominal mass, elevated creatinine, and severe anemia. Based on clinical features and whole exome sequencing, the primary diagnosis was confirmed as TSC. Laboratory and imaging examinations revealed that the lower abdominal mass originated from the uterus. CT-guided biopsy pathology and surgical pathology suggested a combination of leiomyoma and abscess. With the involvement of multiple organs and various complications beyond the main diagnosis, the diagnostic and therapeutic process for this patient highlights the importance of rigorous clinical thinking and multidisciplinary collaboration in the diagnosis and treatment of rare and challenging diseases.

KDM4A promotes the migration and invasion of breast cancer cell line MDA-MB-231 by downregulating BMP9 / 中国癌症杂志

Background and purpose:Exogenous bone morphogenetic protein 9(BMP9)inhibits the malignant progression of human breast cancer,but its expression is often abnormally low in breast cancer.In this study,we intended to explore the expression and role of epigenetically-modified histone lysine-specific demethylase 4A(KDM4A)in breast cancer,and to investigate the relationship between KDM4A and BMP9 and its possible regulatory mechanism.Methods:The expression of KDM4A in breast cancer and its relationship with BMP9 were analyzed by bioinformatics and verified by real-time fluorescence quantitative polymerase chain reaction(RTFQ-PCR)and Western blot.Chromatin immunoprecipitation(ChIP)verified the regulatory role of KDM4A on BMP9,and RNA stability experiments and CHX protein stability experiments verified the effect of KDM4A in BMP9 expression.Exogenous recombinant MDA-MB-231 cells transfected with KDM4A small interfering RNA(siKDM4A)or infected with siBMP9 adenovirus(Ad-siBMP9)were constructed using RNA interference technology and adenoviruses knocking down BMP9,and the migratory and invasive abilities of the cells were detected by scratch healing assay and transwell assay,respectively.Results:Bioinformatics analysis showed that the expression of KDM4A was significantly higher in breast cancer than in normal tissues,and there was a negative correlation between the expression of KDM4A and that of BMP9 in breast cancer;RTFQ-PCR and Western blot showed that KDM4A was highly expressed in different breast cancer cell lines,and the knockdown of KDM4A significantly up-regulated BMP9.ChIP experiment confirmed that KDM4A could be significantly enriched in the promoter region of BMP9 gene,reducing its histone lysine 36 position instead of position 4 methyl status,thus silencing the expression of BMP9.RNA stability assay and CHX protein stability assay confirmed that KDM4A had no significant effect on the mRNA of BMP9,but could affect its protein degradation.After knocking down KDM4A,the migration and invasion abilities of breast cancer cells MDA-MB-231 were significantly inhibited,and this effect could be partially reversed by knocking down BMP9.Conclusion:KDM4A is highly expressed in breast cancer and breast cancer cell MDA-MB-231,and can silence its expression by down-regulating the level of histone methylation in the promoter region of the BMP9 gene,as well as affecting the stability of BMP9 at the protein level rather than at the level of mRNA,and promoting the migration and invasion of breast cancer.

Application of suturing uterine blood vessels with barbed polydioxanone cog thread through transumbilical single-port access large laparoscopic hysterectomy / 中国内镜杂志

Objective To present our initial experience of suturing uterine blood vessels with barbed polydioxanone cog thread by single-port-access large laparoscopic hysterectomy.Methods A respective non-randomized study with two parallel groups was performed from June 2021 to June 2022.The medical records of a total of 41 patients with enlarged uterus were divided into two groups:The single-port access large laparoscopic hysterectomy group by suturing uterine blood vessels with barbed cog thread(experimental group,n = 20),and the four-port assess laparoscopic hysterectomy group(control group,n = 21).The age,body mass index(BMI),a history of abdominal and pelvic surgery,pre-and post-operative hemoglobin(HGB),operative duration,intraoperative bleeding volume,uterine weight,postoperative pain visual analogue scale(VAS)at 24 h,the first postoperative exhaust time and postoperative length of hospital stay were compared between the two groups.Results 41 patients completed the entire procedure successfully without serious complications.Experimental group had a longer median operative time(P<0.01).There were no significant differences in intraoperative bleeding volume,uterine weight,HGB on postoperative day 1,postoperative hospital stays,postoperative exhaust time and postoperative 24-hour pain VAS(P>0.05).Conclusion Our study shows that suturing uterine blood vessels with barbed polydioxanone cog thread in experimental group is safe and feasible for large uterus,but the surgical time is significantly longer than the control group,as the technology becomes more proficient,this situation will be improved.

Analysis of the management and service mechanisms in the integration dilemma of medicine and prevention in China / 中国卫生政策研究

This paper analyzes the main obstacles in the process of promoting the integration of medicine and prevention in China,including the mindset of prioritizing medical care over prevention,fragmented system architecture,conflicting direction of funding and incentives,and inherent contradictions in the division of labor and cooperation in service provision.Furthermore,this article attempts to present the current status and constraints of medical and health integration in China from the perspectives of management mechanisms and service mechanisms,highlighting the mismatch between these two aspects as the root cause.It proposes that the reform logic of current medical and health integration practices should prioritize the service mechanism.This involves clarifying the service interface of medicine and prevention integration and establishing patient-centered service pathways for integration.In the establishment of the service mechanism,a balance should be struck between efficiency and quality,while also integrating based on division of labor.Subsequently,adjustments to the management mechanism should be made in accordance with the medicine and prevention integration service mechanism.In the reform of the management mechanism,various stakeholders'interests should be coordinated and the costs of reform should be controlled.

Study on the measurement and application of diagnostic and treatment difficulty in disease categories / 中国卫生政策研究

This study delineated the conceptual framework of Diagnostic and Treatment Difficulty(DTD)for disease categories for the first time and calculated the coefficient by utilizing disease occurrence probability,average total cost,and cure/improvement rate.The study employed the 2017 data from the New Rural Cooperative Medical Insurance in seven counties or districts to assess the DTD coefficient of inpatient disease categories.It also generated a distribution chart and fitted curve illustrating the relationship between the number of cases and DTD coefficient,in line with disease occurrence patterns.A paired sample Wilcoxon rank-sum test was performed on the DTD coefficient of the same disease categories calculated for two sample counties,yielding non-significant results(p =0.73).This suggests that the algorithm is robust and effectively portrays the occurrence and distribution patterns of disease categories.The measurement results can be utilized to define the scope of disease categories in healthcare institutions and characterize healthcare service supply and demand behavior.However,it's worth noting potential limitations,including a reliance on sample size and subjectivity in weight determination.

Adaptive admittance control for dual-arm surgical robot using radial basis function neural network / 中国医学物理学杂志

Aiming at the problem of large force tracking errors caused by environmental stiffness changes when dual-arm robot is assisting in opening soft tissues in head and neck surgery,an adaptive admittance control strategy based on radial basis function(RBF)neural network is proposed for reducing force tracking error and improving system response speed.By using RBF neural network to adjust admittance parameters online during surgery,the adaptability of the robotic arm to different contact conditions and operation requirements is improved,thereby realizing fast and accurate force tracking.The simulation experiment introduces the adaptive admittance control strategy based on RBF neural network into the dual-arm force synchronous admittance control system and compares it with the traditional fixed-parameter admittance control to prove its contact force control effect under the condition of variable contact environment parameters.The results demonstrate that the adaptive admittance control strategy based on RBF neural network can effectively improve the force tracking accuracy,response speed and anti-interference capability of dual-arm surgical robot.

Analysis of clinical characteristics and the related factors to flare in patients with systemic lupus erythematosus / 中华风湿病学杂志

Objective:To summarize the clinical characteristics and factors that may affect the flare of patients with systemic lupus erythematosus (SLE).Methods:A total of 300 patients with SLE who were treated with standard treatment in the outpatient clinic of the department of rheumatology and immunology of the Second Affiliated Hospital of Air Force Military Medical University of PLA, were enrolled, and the patients were divided into 24 patients in the complete response group, 40 cases in the no response group, 192 cases in the treatment response group, and 44 cases in the low disease activity group according to the response to treatment. The differences in clinical characteristics and survival rates between the groups were compared and analyzed. Comparisons of count data were made using analysis of variance (ANOVA), comparisons of measurement data were made using the chi-square test or the Fisher′s ecact test, and survival rates were expressed as Kaplan-Meier curves. Cox regression analysis was adapted to explore risk factors for flare in these patients.Results:A total of 300 patients were followed. With a median follow-up time of 18 (1, 36) months, a total of 42 patients experienced flare. The clinical characteristics of the four groups were compared, and there were significant differences in age ( F=4.39, P=0.005), the presence of lupus nephritis ( χ2=12.66, P=0.005), hemoglobin level ( F=2.73, P=0.044), NLR level( F=3.88, P=0.010), cystatin C level( F=3.11, P=0.027), anti-RNP antibody ( χ2=12.04, P=0.007), anti-Sm antibody ( χ2=8.33, P=0.040), anti-SSB antibody ( P=0.014), anti-nucleosome antibody ( P=0.014), and anti-ribosomal P protein antibody ( χ2=11.83, P=0.008). There was no significant difference in survival between the four groups. Cox analysis showed that the combination of other autoimmune diseases [ HR(95%CI)=3.23(1.58, 6.57), P=0.001], anti-Sm antibody [ HR(95%CI)=2.15(1.04, 4.43), P=0.038], and anti-RNP antibody [ HR(95%CI)=2.54(1.13, 5.68), P=0.023] were risk factors for flare in patients with SLE who could reach the treatment target. Conclusion:Patients with SLE with different treatment responses have different clinical features, and all treatment can significantly improve the recurrence rate no matter what level of response to treatment. Patients concurrent with other autoimmune diseases, positive anti-Sm antibodies, and positive anti-RNP antibodies are at highrisk of flare.

Analysis of clinical characteristics of patients with systemic lupus erythematosus complicated with decreased level of IgG / 中华风湿病学杂志

Objective:To analyze the clinical features and prognostic factors of patients with systemic lupus erythematosus (SLE) complicated with IgG decrease.Methods:Thirty-five newly diagnosed patients with systemic lupus erythematosus with decreased IgG (<7 g/L) admitted to the Department of Rheumatology of Tangdu Hospital of the Air Force Medical University of the Chinese People′s Liberation Army from January 2016 to March 2022 were included, and 38 hospitalized patients with SLE complicated with elevated or normal IgG during the same period were included as the control group. The clinical data were statistically analyzed. Independent sample t test and χ2 test were used. Results:In the SLE group combined with IgG, the incidence of edema was decreased (31.4% vs. 2.6%, χ2=11.00, P=0.001), and the white blood cell count was decreased [(5.8±0.9)×10 9/L vs. (4.2±0.3)×10 9/L, t=2.49, P=0.015], neutrophil [(4.10±0.48)×10 9/L vs. (2.65±0.25)×10 9/L, t=2.75, P=0.008], the ratio of neutrophil and lymphocyte (4.18±0.65 vs. 2.71±0.24, t=2.18, P=0.032), the ratio of neutrophil and serum albumin (0.186±0.025 vs. 0.071±0.068, t=4.58, P<0.001), the ratio of blood urea nitrogen and serum albumin (0.550 6±0.079 4 vs. 0.048 7±0.002 4, t=6.59, P<0.001), erythrocyte sedimentation rate [(59±7)mm/1 h vs. (33±5)mm/1 h, t=3.06, P=0.003], total cholesterol [(5.95±0.40)mmol/L vs. (3.78±0.14)mmol/L, t=5.26, P<0.001], low density lipoprotein cholesterol [(2.93±0.24)mmol/L vs. (1.84±0.09)mmol/L, t=4.30, P<0.001], creatinine [(178.0±45.2)mmol/L vs. (46.8±1.8)mmol/L, t=3.02, P=0.004], urea nitrogen [(11.92±1.62)mmol/L vs. (4.54±0.25)mmol/L, t=4.67, P<0.001], uric acid [(436±31)mmol/L vs. (278±20)mmol/L, t=4.40, P<0.001], lactate dehydrogenase [(356±72)U/L vs. (208±12)U/L, t=2.11, P=0.038], and α-hydroxybutyrate dehydrogenase [(282±35)U/L vs. (175±11)U/L, t=3.05, P=0.003] were higher than that in normal or elevated IgG groups. Red blood cell [(3.35±0.17)×10 12/L vs. (3.96±0.11)×10 12/L, t=-3.03, P=0.003], hemoglobin [(95±4)g/L vs. (113±4)g/L, t=-3.32, P=0.001], serum albumin [(24.5±1.3)mg/L vs. (38.3±0.9)mg/L, t=-8.79, P<0.001], complement C3 [(0.58±0.04)g/L vs. (0.75±0.05)g/L, t=-2.53, P=0.014], the positive rate of anti-SSA antibody (45.7% vs. 73.7%, χ2=5.95, P=0.015), and the course of disease [(5.6±0.9)year vs. (7.7±0.8) year, t=-7.51, P<0.001] were lower than that of combined normal or elevated IgG groups. The ratio of blood urea nitrogen to serum albumin ( r=-0.47), blood urea nitrogen ( r=-0.36) and uric acid ( r=-0.56) were negatively correlated with complement C3 in patients with IgG reduction group ( P<0.05). Conclusion:Most patients with SLE combined with IgG reduction had edema as the first clinical symptom. Kidney involvement,white blood cell count, neutrophil, the ratio of neutrophil to lymphocyte, the ratio of neutrophil to serum albumin, the ratio of blood urea nitrogen to serum albumin, erythrocyte sedimentation rate, total cholesterol, low density lipoprotein cholesterol, creatinine, urea nitrogen, uric acid, lactate dehydrogenase, and α-hydroxybutyrate dehydrogenase were increased, but red blood cell, hemoglobin, serum albumin, and complement C3 were decreased.Edema was the first clinical presentation, and these patients tend to have more rapidly progression of the disease, and their disease were more severe.

Feasibility of low radiation dose and low contrast dose for coronary CT angiography in obese patients / 中华放射医学与防护杂志

Objective:To evaluate the feasibility of low radiation dose and low contrast dosage in coronary CT angiography (CCTA) of class I obese patients.Methods:This prospective study enrolled 57 patients (male/female, 50/7, age, 25-77 years) with body mass index (BMI) of 30-38 kg/m 2 and body weight of 85-119 kg scheduled for CCTA from August 2022 to March 2023 in our hospital. The patients were divided into two groups: control group (group A, n = 20) and low-dose group (group B, n = 37). Group A employed a standard-dose protocol: tube voltage 120 kVp and IDR 2.2 g I/s, while group B were scanned using the low-dose protocol: tube voltage 100 kVp and IDR 1.5 g I/s. Images in Group A and Group B were reconstructed with hybrid iterative reconstruction (HIR) at strength 4 and 8, respectively. Other scanning and reconstruction parameters were the same in two groups. Methods:The image quality was assessed by measuring the CT values and noise in the aortic root, left anterior descending artery and right coronary artery, and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Subjective image quality was evaluated for vessels according to the 18-segment classification system using a 4-point scale (1. poor, 4. excellent). The effective dose E and contrast dosage were compared. Statistical analysis was performed using independent samples t-test, Mann-Whitney U test or χ 2 test. Results:The BMI of groups A and B were 31.89 (30.77, 33.81) and 31.22 (30.46, 32.83) kg/m 2, respectively ( P>0.05). No statistically significant differences in CT values, noise, SNR, CNR were noticed between the two groups (all P>0.05). The mean subjective score of all coronary artery segments in the two groups were not less than 3, meeting the requirement of clinical diagnosis. There was no statistically significant difference in the overall subjective image quality between the two groups ( P>0.05). The radiation dose E in groups A and B were 7.58 and 4.49 mSv, respectively ( Z=-5.46, P<0.05). The contrast dosage in groups A and B were 66 and 45 ml, respectively. The radiation dose E and contrast dosage in group B were 41% and 32% lower than that in group A, respectively. Conclusions:For class I obese patients, it was feasible to use a low tube voltage (100 kVp) and low IDR (1.5 gI/s) protocol in CCTA. Radiation dose and contrast dosage can be reduced reasonably without compromising the CCTA image quality.

A meta-analysis of the efficacy and safety of robotic surgery versus open surgery in the treatment of hilar cholangiocarcinoma / 中华肝胆外科杂志

Objective:To compare the efficacy and safety of robotic surgery and open surgery in the treatment of hilar cholangiocarcinoma.Methods:PubMed, Embase, Cochrane Library, Web of Science, CNKI and Wanfang database were searched to compare the treatment of hilar cholangiocarcinoma by robotic surgery and traditional open surgery. Literatures were searched from the establishment of the database to July 2023. Compare operation time, intraoperative blood transfusion rate, R 0 resection rate, lymph node metastasis rate, postoperative complication rate and hospital stays between the two groups. The combined odds ratio ( OR) and mean difference ( MD) and 95% confidence interval (95% CI) were calculated using RevMan 5.4 software. Results:A total of 4 studies were included, including 267 patients with hilar cholangiocarcinoma. There were 177 males and 90 females, aged (58.8±5.7) years. A total of 267 patients were divided into open surgery group ( n=165) and robotic surgery group ( n=102) according to the surgical formula. The extract results show: operative time ( MD=-103.96, 95% CI: -216.90-8.98, P=0.070) and intraoperative blood transfusion rate ( OR=1.32, 95% CI: 0.43-4.07, P=0.630), R 0 resection rate ( OR=1.41, 95% CI: 0.71-2.81, P=0.330), lymph node metastasis rate ( OR=1.62, 95% CI: 0.46-5.63, P=0.450), postoperative complications ( OR=0.60, 95% CI: 0.28-1.31, P=0.200), and postoperative hospital stay ( MD=2.17, 95% CI: -11.56-15.90, P=0.760). Conclusion:In the treatment of hilar cholangiocarcinoma, robotic surgery is as safe and feasible as open surgery. However, due to the limited number and quality of included studies, the above conclusions need to be verified by more high-quality studies.

The 504th case: Multiple lymph node enlargement, renal insufficiency, blindness, and white matter lesions of the brain / 中华内科杂志

A 65-year-old male patient was admitted for recurrent lymph node enlargement for 5 years and elevated creatinine for 6 months. This patient was diagnosed with angioimmunoblastic T-cell lymphoma 5 years ago and underwent multiple lines of anti-tumor therapy, including cytotoxic chemotherapy; epigenetic modifying drugs such as chidamide and azacitidine; the immunomodulator lenalidomide; and targeted therapy such as rituximab, a CD20-targeting antibody, and brentuximab vedotin, which targets CD30. Although the tumor was considered stable, multiple virus activation (including BK virus, JC virus, and cytomegalovirus) accompanied by the corresponding organ damage (polyomavirus nephropathy, cytomegalovirus retinitis, and progressive multifocal leukoencephalopathy) occurred during anti-tumor treatment. Anti-tumor therapy was suspended and ganciclovir was used. The serum viral load decreased and organ functions were stabilized. The purpose of this report was to raise clinicians′ awareness of opportunistic virus reactivation during anti-tumor treatment.

Effects of vibrating the abdomen on peripheral blood gastrointestinal hormones and gastrointestinal motility of young anorexia model rats / 针灸推拿医学（英文版）

Objective:To observe the therapeutic effect of vibrating the abdomen on anorexia model rats,as well as its effects on cholecystokinin octapeptide(CCK-8)and motilin(MTL)in the peripheral blood. Methods:Forty young rats were randomly divided into a normal group(n=10)and a modeling group(n=30).Rats in the normal group were fed common feed.The anorexia model was established by the etiological simulation method in the modeling group,and these rats were further randomly divided into a drug group,a vibrating abdomen group,and a model group 3 weeks after the anorexia model was induced,with 10 rats in each group.The drug group was given Jian Wei Xiao Shi Pian by intragastric administration at a dose of 0.72 g/(kg·bw)(0.72 g drug was dissolved in 10 mL purified water).The normal group and the model group were given purified water once a day in the morning.The vibrating abdomen group was treated with vibrating the abdomen once a day for 21 times.The body mass,food intake,serum CCK-8,MTL,gastrin(GAS),neurotensin(NT)levels,and the intestinal propulsion rate of rats in each group were measured. Results:Compared with the model group,the body mass,food intake,serum MTL and GAS levels,and the small intestine propulsion rate increased significantly,and the serum CCK-8 and NT levels,the gastric residual rate decreased significantly in the vibrating abdomen group and the drug group(P<0.05).There were no significant differences between the vibrating abdomen group and the drug group(P>0.05). Conclusion:Vibrating the abdomen increases the food intake and body mass of anorexia model rats,reduces the residue of gastric contents,improves the small intestine propulsion rate,and therefore has a good therapeutic effect on anorexia.The mechanism may be related to inhibiting the secretion of CCK-8 and NT in plasma and promoting the release of MTL and GAS in serum.

Bushen Huoxue Formula （补肾活血方） Combined with Conventional Western Medicine for 129 Patients of Heart Failure with Mid-range Ejection Fraction with Syndrome of Qi Deficiency and Blood Stasis：A Randomized Controlled Trial / 中医杂志

ObjectiveTo evaluate the clinical effectiveness of Bushen Huoxue Formula （补肾活血方） in the treatment of heart failure with mid-range ejection fraction. MethodsA total of 277 patients of heart failure with mid-range ejection fraction with syndrome of qi deficiency and blood stasis were randomly divided into the treatment group （139 cases） and the control group （138 cases）. The control group was given conventional western medicine， and the treatment group was given Bushen Huoxue Formula on the basis of the control group. Both groups were treated for 8 weeks. Left ventricular ejection fraction （LVEF）， N-terminal B-type natriuretic peptide （NT-pro BNP） level， cardiac function grade， Minnesota heart failure quality of life score， anxiety score， depression score， and the major incidence of cardiovascular adverse events and re-hospitalization rate after 6-month treatment were compared between the two groups before and after treatment. ResultsThere were 10 withdrawals in the treatment group and 6 withdrawals in the control group， so 129 cases in the treatment group and 132 cases in the control group completed the trial. After treatment， LVEF increased and NT-pro BNP level decreased in both groups （P＜0.05）； compared with those in the control group， LVEF increased and NT-pro BNP level decreased in the treatment group （P＜0.05）. The total rate of graded improvement of cardiac function in the treatment group （97.67%， 126/129 cases） was higher than that in the control group （84.09%， 111/132 cases） （P＜0.05）. After treatment， the Minnesota heart failure quality of life score， anxiety score， and depression score were lower in both groups （P＜0.05）， and the above scores in the treatment group were lower than those in the control group （P＜0.05）. After 6-month treatment， there was no death event in both groups， and there was no significant difference in the major incidence of cardiovascular adverse events between the treatment group （25.58%， 33/129 cases） and the control group （33.33%， 44/132 cases） （P＞0.05）. The rate of re-hospitalization in treatment group （14.73%， 19/129 cases） was lower than that in control group （30.30%， 40/132 cases） （P＜0.05）. ConclusionBushen Huoxue Formula can increase LVEF， reduce NT-pro BNP， improve quality of life， improve anxiety and depression， and reduce the rate of re-hospitalization in patients of heart failure with mid-range ejection fraction with syndrome of qi deficiency and blood stasis.

A Case Report of Multidisciplinary Diagnosis and Treatment of a Patient with Tuberous Sclerosis Complex and Multi-Organ Involvement / 罕见病研究

Tuberous sclerosis complex(TSC)is a rare genetic disease that can lead to benign dysplasia in multiple organs such as the skin, brain, eyes, oral cavity, heart, lungs, kidneys, liver, and bones. Its main symptoms include epilepsy, intellectual disabilities, skin depigmentation, and facial angiofibromas, whilst incidence is approximately 1 in 10 000 to 1 in 6000 newborns. This case presents a middle-aged woman who initially manifested with epilepsy and nodular depigmentation. Later, she developed a lower abdominal mass, elevated creatinine, and severe anemia. Based on clinical features and whole exome sequencing, the primary diagnosis was confirmed as TSC. Laboratory and imaging examinations revealed that the lower abdominal mass originated from the uterus. CT-guided biopsy pathology and surgical pathology suggested a combination of leiomyoma and abscess. With the involvement of multiple organs and various complications beyond the main diagnosis, the diagnostic and therapeutic process for this patient highlights the importance of rigorous clinical thinking and multidisciplinary collaboration in the diagnosis and treatment of rare and challenging diseases.

Analysis of depressive symptoms and influencing factors among middle and high school students from 2018 to 2021 in Zhejiang Province / 中国学校卫生

Objective@#To investigate the prevalence and associated factors of depressive symptoms among middle and high school students in Zhejiang Province, so as to provide scientific basis for the implementation of depressive intervention.@*Methods@#Based on the health status and associated factors of middle and high school students in the project "Monitoring of Common Diseases and Health Influencing Factors of Students" during 2018 to 2021, a total of 73 309 students including middle school, ordinary high school and vocational high school surveyed in 11 cities of Zhejiang Province were selected by multi stage stratified cluster random sampling method. From 2018 to 2021, there were 6 008, 21 917, 23 712 and 21 672 students, respectively. The Chi square test and Logistic regression model were used to analyze the influencing factors of depressive symptoms in middle and high school students.@*Results@#From 2018 to 2021, depressive symptoms detection rate of middle school students was 14.8%, with higher rate in girls (17.1%) than in boys (12.7%), higher rate in high school (17.1% in ordinary high school, 17.6% in vocational high school) than middle school (12.5%)( χ 2=278.77, 327.22, P <0.05). Univariate analysis showed that there were statistically significant differences in depressive symptoms detection rate among middle school students with different years (2018: 16.7%，2019: 17.9% , 2020: 13.1%, 2021: 13.0%), residence (yes: 16.3%, no:13.5%), body mass index classification (not overweight or obesity: 14.8%, overweight: 14.2%, Obesity: 15.7%), weekly exercise days (0-2 d: 17.1%, 3-5 d: 12.5%, 6-7 d: 13.1%) and bullying (yes: 35.5%, no: 10.7%) ( χ 2=293.40, 118.35, 7.83, 287.24, 4 978.84, P <0.05). Multivariate Logistic regression analysis showed that female students, ordinary high schools, vocational high schools, obesity, school bullying were positively correlated with depression ( OR =1.65, 1.70, 1.60, 1.12, 5.21), exercise 3 to 5 days per week, exercise 6 to 7 days per week were negatively correlated with depression ( OR=0.77, 0.81, P <0.01).@*Conclusions@#Depressive symptoms among middle and high school students in Zhejiang Province are prominent. Strengthening mental health education for students and providing attention and support from families, schools, and society are essential steps to reduce the occurrence of depressive symptoms among these students.

Impact of excessive pregnancy weight gain on pregnancy outcomes and neonatal conditions in pre-pregnancy overweight and obese women / 上海预防医学

ObjectiveTo explore the influence of excessive weight gain during pregnancy in pre-pregnancy overweight and obese women on pregnancy outcomes and neonatal conditions， and to provide scientific evidence for formulating weight management strategies before and during pregnancy and prevent adverse pregnancy outcomes. MethodsClinical data of 2 172 parturients collected from a community in Huangpu District from 2017 to 2021 were retrospectively analyzed， and they were divided into pre-pregnancy overweight and obesity group （n=530）， normal pre-pregnancy weight group（n=937）， and underweight pre-pregnancy group（n=705） according to maternal precursor body mass index （BMI）. Based on their weight gain during pregnancy，the parturient were divided into moderate gestational weight gain （MGWG） group and excessive gestational weight gain （EGWG） group. Meanwhile， the pregnancy and neonatal outcomes such as postpartum hemorrhage， puerperal infection， placental abruption， premature rupture of membranes， mode of delivery， premature birth， stillbirth， fetal distress， admission to the intensive care unit （ICU）， macrosomia， and Apgar score， were recorded. Then the differences in pregnancy and neonatal outcomes between groups were compared. The effects of pre-pregnancy BMI and gestational weight gain on pregnancy outcomes and neonatal conditions was retrospectively analyzed. ResultsThe pre-pregnancy overweight and obese group had higher proportions of placental abruption， premature rupture of membranes， cesarean section， premature birth， fetal distress， and macrosomia compared to the normal pre-pregnancy weight group and the underweight pre-pregnancy group， with Apgar scores lower than the normal pre-pregnancy weight group and the underweight pre-pregnancy group （all P<0.05）. The EGWG group had higher proportions of postpartum hemorrhage， placental abruption， premature rupture of membranes， cesarean section， premature birth， fetal distress， admission to the ICU， and macrosomia than the MGWG group （all P<0.05）. In the pre-pregnancy overweight and obese group， the EGWG group had higher proportions of placental abruption， premature rupture of membranes， premature birth， fetal distress， admission to the ICU， and macrosomia than the MGWG group， with lower Apgar scores than the MGWG group （all P<0.05）. In the normal pre-pregnancy weight group， the EGWG group had higher proportions of placental abruption， premature rupture of membranes， premature birth， fetal distress， admission to the ICU， and macrosomia than the MGWG group （all P<0.05）. In the pre-pregnancy overweight and obese group， the EGWG group had higher proportions of premature rupture of membranes， cesarean section， premature birth， fetal distress， and macrosomia than the EGWG group in the normal pre-pregnancy weight group（all P<0.05）. Logistic regression analysis showed that EGWG in pre-pregnancy overweight and obese women was a risk factor for placental abruption （OR=2.971， 95%CI： 1.098‒8.042）， premature rupture of membranes （OR=4.662， 95%CI： 2.798‒7.770）， cesarean delivery （OR=1.375，95%CI： 1.260‒2.541）， premature birth （OR=4.249， 95%CI： 2.384‒7.573）， fetal distress （OR=3.238， 95%CI： 1.589‒6.598）， admission to the ICU （OR=3.010， 95%CI： 1.265‒7.164）， and macrosomia （OR=5.437， 95%CI： 3.392‒8.716） （all P<0.05）. ConclusionExcessive gestational weight gain in pre-pregnancy overweight and obese women is a risk factors for placental abruption， premature rupture of membranes， cesarean section， premature birth， fetal distress， admission to the ICU， and macrosomia.

Background radioactivity levels of gross α and gross β in foods around Zhangzhou nuclear power plant, China / 中国辐射卫生

Objective To investigate the radioactivity levels of gross α and gross β in foods around Zhangzhou nuclear power plant, China before operation. Methods Forty-nine samples from 33 kinds of foods in 5 categories of daily food around Zhangzhou nuclear power plant were collected, pretreated, dried, and ashed. The radioactivity levels of gross α and gross β were measured by the low-background α and β measuring instrument. The atomic absorption technique was employed to measure the level of potassium (K), and the radioactivity level of gross β (subtracting 40K) was calculated with K concentrations in different foods consulted from the nutritional dietary system. Results The radioactivity levels of gross α in vegetables and fruits, grain, poultry and livestock, aquatic products, and tea around Zhangzhou nuclear power plant were < minimum detectable level (MDL)-7.97, < MDL-6.82, < MDL, < MDL-20.76, and 11.90-23.08 Bq/kg, respectively; the radioactivity levels of gross β were 34.56-122.81, 13.05-188.96, 56.00-108.34, 17.86-169.01, and 123.74-171.63 Bq/kg, respectively; the radioactivity levels of gross β (subtracting 40K) were not detected (ND)-14.27, ND-27.86, ND-48.72, ND-45.85, and 6.69-13.79 Bq/kg, respectively. Conclusion The radioactivity of gross α and gross β in foods around Zhangzhou nuclear power plant before operation is basically at the same level as that in other areas of China.

Analysis of the efficacy and prognosis of radiotherapy in acute leukemia with extramedullary infiltration / 重庆医学

Objective To investigate the clinical characteristics,treatment methods,and prognosis of a-cute leukemia patients with extramedullary infiltration.Methods The clinical characteristics and treatment methods of 47 acute leukemia patients with extramedullary infiltration admitted to the Affiliated Hospital of Guizhou Medical University from April 2014 to April 2023 were retrospectively analyzed.Subgroup analysis was performed according to whether there was extramedullary infiltration before transplantation,and whether there was isolated extramedullary recurrence after transplantation.Based on this analysis,the patients were di-vided into the pre-transplantation radiotherapy group and pre-transplantation non-radiotherapy group,the post-transplantation radiotherapy group and post-transplantation non-radiotherapy group.According to the treatment methods of central nervous system leukemia(CNSL),the patients were divided into the intrathecal injection group(n=12)and combination of intrathecal injection and radiotherapy group(n=13).The local remission situation,survival duration,and toxic and side effects of radiotherapy and chemotherapy were com-pared.Results For acute leukemia patients with extramedullary infiltration,the overall survival time(OS)in the radiotherapy group was better than that in the non-radiotherapy group(median OS:706 d vs.151 d,P=0.015).Subgroup analysis showed that the OS of the pre-transplantation radiotherapy group was better than that of the pre-transplantation non-radiotherapy group(median OS:592 d vs.386 d,P=0.035).For CNSL,the combination of intrathecal injection and radiotherapy group had a better OS than the intrathecal injection group(median OS:547 d vs.388 d,P=0.045).The event-free survival time(EFS)of the radiotherapy group was better than that of the non-radiotherapy group(median EFS:175 d vs.50 d,P=0.005).The COX pro-portional-hazards model showed that treatment with or without radiotherapy had a significant impact on the OS of acute leukemia patients with extramedullary infiltration.The risk of death in the pre-transplantation non-radiotherapy group was 2.231 times higher than that in the pre-transplantation radiotherapy group(HR=3.231,95％CI:1.021-10.227,P=0.046).Compared with the non-radiotherapy group,the radiother-apy group had a higher local remission and a lower risk of haematological toxicity,infection,and haemorrhage.Conclusion Radiotherapy can rapidly alleviate the local symptoms of acute leukemia complicated with extr-amedullary infiltration,prolong the survival time of these patients,and reduce the risk of hematologic toxicity,infection,and haemorrhage.

Dosimetric comparison between abdominal deep inspiration breath hold and free breath in intensity modulated radiotherapy for left breast cancer / 重庆医学

Objective To explore the dosimetric differences between abdominal deep inspiration breath hold(ADIBH)mode and free breath(FB)mode in intensity modulated radiation therapy(IMRT)for left breast cancer.Methods From July 2022 to May 2023,a total of 22 patients who needed adjuvant radiation therapy after left breast cancer surgery in the hospital were selected as the research objects.The simulated computed tomography(CT)positioning images of ADIBH and FB modes were collected,the planned target volume(PTV)and endangered organs were outlined,the IMRT plan was designed,and the dosimetric param-eters of the two modes were compared.Results There was no significant difference in the mean dose(Dmean),homogeneity index(HI)and conformity index(CI)of PTV between the ADIBH and the FB modes(P＞0.05).Compared with the FB mode,the heart Dmean,V5,V10,V20,V30 and V40 in the ADIBH mode decreased by 2.95 Gy,12.21％,8.26％,6.56％,5.41％and 3.48％,respectively,and the left anterior descending(LAD)coronary artery Dmean,maximum dose(Dmax),minimum dose(Dmin)and V40 decreased by 15.99 Gy,16.10 Gy,0.82 Gy and 13.73％,respectively,with statistical significance(P＜0.05).Compared with the FB mode,the dose and volume of heart irradiation in the ADIBH mode at the same level were significantly reduced.Pearson correlation analysis showed that there was a positive correlation between heart Dmean and LAD Dmean in the ADIBH mode(r=0.72),and between heart Dmean and LAD Dmean in the FB mode(r=0.69).Compared with the FB mode,the left lung Dmean of the ADIBH mode decreased by 0.99 Gy,and the difference was statistically significant(P＜0.05).However,there was no significant difference in left lung V5,right lung Dmean and right breast Dmean between the two breathing modes(P＞0.05).Conclusion ADIBH mode can effectively reduce the dose to the heart and LAD,and play a good protective role.

Clinical Analysis of 311 Cases with Giant Ovarian Mass / 实用妇产科杂志

Objective:To analyze the clinicopathological features of giant ovarian masses(mean diameter≥10 cm)and analyze the clinical characteristics of patients in different age groups.Methods:The clinicopathological characteristics of 311 patients diagnosed with giant ovarian masses by surgery at Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University from January 2014 to December 2022 were retrospectively analyzed.Patients were further stratified by age and mass size to compare the differences of clinical and patho-logical features among different age groups and different mass diameter groups.Results:①The median age of thepatients were 44(24,60)years old.The first symptoms were as follows:ovarian mass discovered during physi-cal examination,abdominal pain,bloating,conscious abdominal distension,and symptoms of compression.②The surgical methods were as follows:unilateral oophorectomy(30.5％,95/311),ovarian cystectomy(28.9％,90/311),tumor staging or cytoreductive surgery(28.0％,87/311),total hysterectomy with bilateral adnexectomy(12.5％,39/311).③The pathological types were benign(49.5％,154/311),malignant(31.8％,99/311)and borderline(18.7％,58/311).④ Patients complained abdominal distension in＜20 years old group were signifi-cantly higher than the other two groups(P＜0.05).The ovarian resection rate in the＞50-year-old group was higher than that of the other two groups(P＜0.05),and the rate of unilateral ovarian resection in the＜20-year-old group was still as high as 30.1％(15/49).⑤ The size of the mass correlated with the duration of the disease.When the disease course was between 1 to 6 months,the mass diameter line＞30 cm was the most common(P＜0.05).The incidence of borderline tumors in the＞30 cm group was significantly higher than that in the other two groups,and the difference was statistically significant(P＜0.05).Conclusions:Ovarian mucinous and mucinous borderline tumors are the most common types of giant adnexal masses.The size of the mass tends to increase with the prolongation of the disease course.The incidence of borderline tumors increases with the in-crease of mass.Health education for young people should be strengthened.When abdominal pain,abdominal bloating,especially lower abdominal distension occurs,they should seek medical treatment in time to avoid adnex-ectomy due to borderline tumors.