Genome-wide identification and transcriptional profiling analysis of PIN/PILS auxin transporter gene families in Panax ginseng / 中草药·英文版

Objective: Plant hormones act as chemical messengers in the regulation of plant development and metabolism. The production of ginsenosides in Panax hybrid is promoted by auxins that are transported and accumulated by PIN-FORMED (PIN) and PIN-LIKES (PILS) auxin transporters. However, genome-wide studies of PIN/PILS of ginseng are still scarce. In current study, identification and transcriptional profiling of PIN/PILS gene families, as well as their potential relationship with ginsenoside biosynthesis in Panax ginseng were investigated. Methods: PIN/PILS genes in P. ginseng was identified via in silico genome-wide analysis, followed by phylogenetic relationships, gene structure, and protein profiles investigation. Moreover, previously reported RNA-sequence data from various tissues and roots after infection were utilized for PIN/PILS genes expression pattern analysis. The Pearson's correlation analysis of specific PIN/PILS genes expression level and main ginsenoside contents were taken to reveal the potential relationship between auxin transports and ginsenoside biosynthesis in P. ginseng. Results: A genome-wide search of P. ginseng genome for homologous auxin transporter genes identified a total of 17 PIN and 11 PILS genes. Sequence alignment, putative motif organization, and sub-cellular localization indicated redundant and complementary biological functions of these PIN/PILS genes. Most PIN/PILS genes were differentially expressed in a tissue-specific manner, and showed significant correlations with ginsenoside content correspondingly. Eight auxin transporter genes, including both PIN and PILS subfamily members, were positively correlated with ginsenoside content (cor > 0.60; P-value <0.05). The expression levels of eleven auxin transporter genes were increased dramatically in the early stage (0–0.5 DPI) after Cylindrocarpon destructans infection, accompanied with various overall expression patterns, implying the dynamic auxin transport in response to biotic stress. Conclusion: Based on the results, we speculate that the accumulation or depletion in temporal or spatial manner of auxin by PIN/PILS transporters involved in the regulation of HMGR activity and subsequent ginsenoside biosynthesis.

Social support status and influencing factors among schizophrenics in remission in Northeast Sichuan / 四川精神卫生

ObjectiveTo investigate the social support status and influencing factors of schizophrenics in remission in Northeast Sichuan， and to provide ideas for improving their social support. MethodsFrom May to September 2020， a total of 533 patients who met the diagnosis criteria of the International Classification of Diseases， tenth edition （ICD-10） for schizophrenics in remission at the mental health institutions in Guangyuan， Bazhong and Dazhou cities were selected for the survey， and patients were assessed by self-made demographic and clinical data inventory and Social Support Rating Scale （SSRS）. Then the social support status of schizophrenic in remission and influencing factors were analyzed， meantime， the impact of the second round reimbursement policy of medical insurance benefits on their social support was addressed particularly. Results①The SSRS total score， objective support， subjective support， and utilization of support scores of schizophrenics in remission were lower than those of the national norm （t=5.065~30.382， P<0.01）. ②Univariate analysis showed that SSRS score was relatively high among patients with female gender （t=-3.632）， retired status （F=5.951）， married status （F=5.951）， spouse as primary caregiver （F=23.841）， annual household income >5 000 yuan （F=15.892）， patient's economic income （t=4.083）， and outpatient or online follow-up （F=3.954）， with statistically significant differences （P<0.05 or 0.01）. ③The total and dimensional scores of SSRS in patients with access to the second round medical insurance reimbursement were significantly higher than those without （t=10.195~25.103， P<0.01）. ④Multiple linear regression analysis denoted that gender， work status， marital status， primary caregivers， annual family income， economic income， follow-up visits and the second round medical insurance reimbursement were the factors influencing social support status of schizophrenics in remission （β=0.201~2.115， P<0.05 or 0.01）. ConclusionThe social support of schizophrenics in remission in Northeast Sichuan is below the national average， furthermore， their social support levels are affected by the gender， work status， marital status， primary caregivers， annual family income， economic income， follow-up visits and the second round medical insurance reimbursement， and the second round medical insurance reimbursement may ameliorate the social support status of patients.

Survey on psychosocial services in northeast Sichuan / 四川精神卫生

ObjectiveTo investigate the current status of psychosocial services in various institutions as well as the mental health status of residents in Northeast Sichuan， so as to provide references for the further construction and implementation of psychosocial services in this area. MethodsA total of 148 institutions in Tongjiang county of Bazhong city， Lizhou district of Guangyuan city and Dazhu county of Dazhou city were surveyed through self-compiled questionnaires covering the construction status of psychosocial service system and the implementation of mental health service in each institution. Meantime， the mental health status and psychological service needs of 21 505 residents in pilot areas of three cities were investigated using the Patients' Health Questionnaire Depression Scale-9 item （PHQ-9）， Generalized Anxiety Disorder Scale-7 item （GAD-7） and the self-designed mental health service needs questionnaire. ResultsAmong the 148 institutions in the pilot areas， 81 （54.7%） of which had dedicated mental health service， and 58 （39.2%） were equipped with full-time or part-time mental health service personnel. In 2019， 95 （64.2%） institutions conducted mental health services for employees， and 104 （70.3%） conducted mental health propaganda activities. Of the 75 educational institutions， 67 （89.3%） conducted mental health education for students， and 47 （62.7%） achieved full coverage of the mental health education curriculum among students. The detection rates of depression and anxiety among the residents were 36.8% and 30.8%， respectively， and 83.7% of the residents had the mental health service needs， mainly in the aspects of personal growth， marriage and family， children's education and stress management. ConclusionThe psychosocial services in the pilot areas of the three cities in northeast Sichuan are well conducted， while the guarantee of workplace， funds and personnel remains to further strengthen. Furthermore， residents have prominent emotional problems such as depression and anxiety， and have a high demand for mental health services.

Analysis of the detection of non-caseating granuloma under endoscopy in 199 patients with Crohn′s disease / 中华消化杂志

Objective:To explore the detection rate of non-caseating granuloma under endoscopy in patients with Crohn′s disease and its influencing factors, in order to improve the pathological diagnosis rate of Crohn′s disease.Methods:From July 2016 to April 2021, at the First Affiliated Hospital of Soochow University, 199 patients who met the clinical diagnostic criteria for Crohn′s disease and underwent endoscopic biopsy were collected. The detection rates of non-caseating granulomas in all patients with Crohn′s disease, in different types (primary and recurrent) and whether the biopsy site included the colon were analyzed. According to whether non-caseating granulomas were detected by endoscopic biopsy, the patients were divided into the detected group and the undetected group. The clinical data of the two groups of patients were compared, which included gender, age, course of disease, body mass index, smoking status, clinical manifestations (abdominal pain, diarrhea, gastrointestinal bleeding, perianal lesions, weight loss, fever, intestinal obstruction), therapeutic medication (5-aminosalicylic acid, immunosuppressants, glucocorticoid, biological agents, exclusive enteral nutrition), history of bowel surgery, laboratory examination results (hemoglobin, platelet count, neutrophil count, C-reactive protein, erythrocyte sedimentation rate, albumin), endoscopic manifestation (ulcer, fistula, stricture), simplified Crohn′s disease activity index (CDAI), total number of biopsy samples, and site of biopsy. Chi-square test, continuity correction chi-square test, Mann-Whitney U test and Fisher exact test were used for statistical analysis, and logistic regression analysis was used to analyzed the influencing factors of detection of non-caseating granulomas under endoscopy. Results:Among the 199 patients with Crohn′s disease, 67 cases were detected with non-caseating granuloma (detected group), and the overall detection rate was 33.7% (67/199); 132 cases were not detected with non-caseating granuloma (undetected group). The detection rate of non-caseating granulomas in patients with primary Crohn′s disease was higher than that of recurrent patients (39.9%, 59/148 vs. 15.7%, 8/51), and the detection rate of non-caseating granulomas in patients with Crohn′s disease whose biopsy site included the colon was higher than that of patients whose biopsy site did not include colon (64.1%, 25/39 vs. 26.3%, 42/160), and the differences were statistically significant ( χ2=9.93 and 20.12 , P=0.002 and <0.001). The age of patients in the detected group was younger than that of the undetected group; the course of disease of the detected group was shorter than that of the undetected group; the proportions of patients with abdominal pain and history of biological treatment in the detected group were lower than those of the undetected group; the simplified CDAI score of the detected group was higher than that of the undetected group; and the total number of biopsy samples of the detected group was more than that of the undetected group (30.0 years old (25.0 years old, 37.00 years old) vs. 32.0 years old (28.0 years old, 41.0 years old); 1.0 year (0.0 year, 3.0 years) vs. 2.0 years (0.0 year, 5.0 years), 61.2%, 41/67 vs. 75.8%, 100/132; 0, 0/67 vs. 10.6%, 14/132; 5.00 (2.00, 7.00) vs. 4.00 (2.00, 6.00); 10 (8, 12) vs. 6 (3, 9)), and the differences were statistically significant ( Z=-2.29, -1.99, χ2=4.56, corrected χ2=6.11, Z=-2.05, -5.64, all P<0.05). The case number of biopsy location in terminal ileum, colon, ileocolon, upper gastrointestinal tract, terminal ileum+ upper gastrointestinal tract, ileocolon+ upper gastrointestinal tract in the detected group was 36, 4, 18, 1, 5 and 3, respectively, compared with those of undetected group (94, 4, 8, 11, 13 and 2), the difference was statistically significant (Fisher′s exact test, P<0.001). The results of multivariate logistic regression analysis suggested that the total number of biopsy samples, whether the biopsy site included the colon and disease type were independent influencing factors for the detection of non-caseating granulomas under endoscopy in patients with Crohn′s disease (regression coefficients=0.157, 0.979 and -0.960, OR=1.171, 2.662 and 0.383; 95% confidence interval 1.067 to 1.284, 1.140 to 6.214, 0.158 to 0.929; P=0.001, 0.024 and 0.034). Conclusions:For endoscopic examination in patients with suspected Crohn′s disease, the total number of biopsy samles should be increased as much as possible, and biopsy should be performed at the colonic lesions, in order to improve the detection rate of non-caseating granulomas under endoscopy thereby providing more pathological evidence for the diagnosis of Crohn′s disease.

Application of 3D image fusion technique of enhanced CT and magnetic resonance neurography on pelvic fractures with lumbosacral plexus injury / 中华骨科杂志

Objective:To investigate the application of three-dimensional (3D) image fusion technique of pelvic enhanced CT and magnetic resonance neurography (MRN) on the patients of pelvic fractures with lumbosacral plexus injury.Methods:From January 2019 to December 2020, 15 patients (11 males, 4 females, mean age 26.67±11.34 of pelvic fracture (AO classification C1.3 of 11 cases, C2 of 2 cases, C3 of 2 cases) with lumbosacral plexus injury underwent 3D image fusion of pelvic enhanced CT and MRN. All patients exhibited lower limb nerve dysfunction after injury. The preoperative muscle strength were evaluated by British Medical Research Council (BMRC) criteria: grade 0 in 2 cases, grade 1 in 5, grade 2 in 7 and grade 3 in 1. Physical examination and enhanced CT combined with MRN 3D image fusion technology were used to accurately determine the injury site of lumbosacral plexus nerve, fracture displacement, and the direction of blood vessels and ureters, and develop corresponding surgical plans. The neurological functions were measured in post-operation follow-up.Results:All 15 operations were successfully completed and the site of lumbosacral plexus injury during operation was consistent with preoperative fusion image, and inconsistency of injury characteristic in 4 patients (4/15, 27%). Among the 6 cases of laparoscopic surgery, 2 cases were changed to open surgery because of the difficulty of nerve decompression. The average time of 4 cases of laparoscopic surgery was 116.27±26.46 min and intraoperative blood loss was 102.50±79.32 ml. The average time of 11 cases of open operation was 123.64±38.28 min, and intraoperative blood loss was 713.64±393.12 ml. For the opening operations, 9 cases were successfully decompressed, and nerve disruption was observed in 2 patients. All 15 patients were followed up. The average follow-up time was 9.33±2.19 months. The radial bony healing was observed in each case at the end of follow-up, mean healing time was 5.03±1.04 months (range, 3-6 months). In addition, patients' muscle strength recovered, 8 cases of grade 5, 3 cases of grade 4, 1 case of grade 3, 1 case of grade 2, and 2 cases of grade 0 after surgery. The difference was statistically significant ( Z=3.27, P<0.001). On the other hand, in sensory function assessment, there were 8 cases of grade S5, 1 case of grade S4, 3 cases of grade S3, 1 case of grade S2 and 2 cases of grade S0 after surgery. Conclusion:3D image fusion of enhanced CT and MRN can accurately locate and characterize pelvic fractures combined with lumbosacral plexus injury before surgery, accurately guide the formulation of surgical plan, and reduce surgical trauma and related complications.

Expression and Clin ical Significance of B7-H5 in Ulcerative Colitis / 胃肠病学

Background: The incidence of ulcerative colitis (UC) has gradually increased in China in recent years. The pathogenesis of UC is related to the dysfunction of immune system. B7-H5 is an important immune checkpoint molecule and is significant for the regulation of immune function. Ainis: To investigate the expression and clinical significance of B7-H5 in UC. Methods: A total of 65 UC tissue specimens were collected from Jan. 2010 to Dec. 2020 at the First Affiliated Hospital of Soochow University, and 5 healthy subjects were served as controls. Immunohistoehemistry and immunofluorescence were used to detect the expression of B7-H5, and its relationship with elinieopathologieal characteristics of UC patients was analyzed. Results: Expression of B7-H5 was significantly increased in UC patients than in controls (P 0. 05). Conclusions; The expression of B7-H5 in UC patients is significantly increased and is correlated with ESR and CRP, and can be used as a new marker for reflecting the severity of inflammation in UC patients.

Effectiveness and safety of nanoknife ablation guided by real-time virtual sonography in treatment of locally advanced pancreatic cancer / 临床肝胆病杂志

ObjectiveTo investigate the effectiveness and safety of nanoknife ablation guided by real-time virtual sonography (RVS) in the treatment of locally advanced pancreatic cancer (LAPC). MethodsA retrospective analysis was performed for the clinical data of 27 patients with LAPC who attended The Fifth Affiliated Hospital of Zhengzhou University from April 2018 to October 2019, and according to the treatment method, the patients were divided into combination group (12 patients treated with IRE combined with chemotherapy) and control group (15 patients treated with chemotherapy alone). The chemotherapy regimen was gemcitabine combined with tegafur, gimeracil and oteracil potassium for both groups. Adverse reactions and complications were observed for the combination group during the perioperative period, and the two groups were compared in terms of the changes in myocardial enzymes, blood amylase, and carbohydrate antigen 19-9 (CA19-9) before treatment and at different time points after treatment, as well as remission rate (RR) and disease control rate (DCR) at 3 months after treatment and survival status during follow-up. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups, and the Wilcoxon test was used for comparison within each group; the Fisher’s exact test was used for comparison of categorical data between groups; the Kaplan-Meier method was used to analyze the survival status during follow-up. ResultsIn the combination group, there were 12 cases of adverse reactions and mild complications during the perioperative period, i.e., 9 Clavien-Dindo grade I cases and 3 grade II cases. All patients in the combination group experienced a transient increase in myocardial enzymes, which returned to normal within 7 days, and there were no significant changes in creatine kinase and lactate dehydrogenase on day 7 after treatment (P＞0.05); 9 patients had a significant increase in blood amylase on day 1 after surgery, which significantly decreased on day 7 after surgery and basically returned to normal on day 14 after surgery, and there was no significant change in blood amylase on days 7、14， and 1 month after surgery (P＞0.05). Before treatment, the level of CA19-9 was higher than the normal value in both groups, and the combination group had a significant reduction in CA19-9 at 1, 2, and 3 months after treatment (all P＜005); in the control group, the level of CA19-9 firstly decreased for a short time and then increased, while there was no significant change in CA19-9 at 1, 2, and 3 months after treatment (all P＞0.05). At 3 months after treatment, the combination group had significantly higher RR and DCR than the control group (RR: 75.0% vs 26.7%, P=0.021; DCR: 91.6% vs 53.3%, P=0043). During the median follow-up time of 13 months, compared with the control group, the combination group had significantly higher median progression-free survival time (10 months vs 5 months, P=0.014) and median overall survival time (18 months vs 10 months, P=0.034). ConclusionRVS-guided percutaneous nanoknife ablation has marked clinical effect and high safety in the treatment of LAPC and can be used as a new treatment option for patients who refuse or cannot tolerate laparotomy for ablation therapy.

The clinical analysis of scleral buckling for rhegmatogenous retinal detachment of 376 patients / 中华眼底病杂志

Objective:To analyze the clinical efficacy of scleral buckling surgery for rhegmatogenous retinal detachment (RRD) of 376 patients.Methods:A retrospective analysis was performed about 376 patients (391 eyes) who underwent scleral buckling surgery in Chengdu Aidi Eye Hospital from January 2018 to December 2019. There were 214 males (224 eyes) and 162 females (167 eyes). There were 15 binocular cases and 361 monocular cases. The average age was 37.16±16.36 years. The average course of disease was 3 months. There were 1 to more than 10 retina holes for all patients. Retinal breaks occur in all quadrants and at ora serrata. The preoperative average BCVA was 0.27 and the postoperative average BCVA was 0.41. Retinal detachment ranges was observed in 268 eyes in 1 quadrant, 97 eyes in 2-3 quadrants, 26 eyes in total, and 231 eyes with macular involvement. There were 376 eyes treated with scleral buckling, 9 eyes treated with scleral buckling combined with scleral encircling, 6 eyes treated with scleral encircling. The average follow-up time was 5 months. Postoperative follow-up was conducted to observe retinal reduction, BCVA, complications and patient compliance.Results:After the first operation, retinal reattachmnents were successfully achieved in 375 eyes (95.91%); 16 eyes (4.09%) failed in retinal reattachmnents. Eight eyes were treated with scleral buckling again, 5 eyes were treated with vitrectomy silicone oil filling, and 3 eyes were treated with air injection. After the second operation, retinal reattachmnents were ultimately achieved in 16 eyes (100.00%). The average BCVA after operation was 0.15. Postoperative intraocular pressure increased by 45 eyes (11.51%). The intraocular pressure increased from the next day to 3 days after operation. The intraocular pressure was completely controlled 1-3 days after the treatment of topical medication and 20% mannitol. Vitreous and subretinal hemorrhage in 1 eye caused by drainage of the subscleral liquid. There was no cases with postoperative infection.Conclusion:The retinal reattachment rate is 95.91% in 376 patients with RRD treated by scleral buckling surgery, and the visual acuity has significantly improved.

A status survey on clinical teaching towards postgraduates of master of nursing specialist in China / 中国实用护理杂志

Objective:To investigate the current status of clinical teaching towards postgraduates of master of nursing specialist(MNS) in China.Methods:Objective sampling was used to invest 390 MNS clinical nursing teachers in 36 hospitals across the country. The survey included the admission and evaluation criteria of teachers, the MNS postgraduates′ clinical teaching plan and implementation, and the assessment of MNS postgraduate ′s clinical practice ability, etc. Results:Among the criteria for clinical teachers for MNS postgraduates, 79.49% of departments required bachelor ′s degree or above, and 67.18% of departments requested medium-grade professional title or above; 47.44% of the departments demanded that clinical teachers had the research experience, 58.21% departments asked for the experience of articles publication. The main method of selecting clinical teaching teachers was examination (50%), while 31.28% departments had no definite criteria. The evaluation indicators of clinical teachers mainly depended on the results of students ′ clinical practice capability assessment (81.79%) and students ′ satisfaction (80%). Only 49.23% of the study objects knew the training objectives of MNS. The pivotal abilities of MNS graduate students were the ability of clinical nursing practice (91.79%) and clinical research (82.82%). The MNS postgraduate teaching plan of each department was mainly derived from the requirements of tutors and colleges (87.69%). The mode of clinical teaching was that one student was guided by a fixed clinical teacher (87.18%). Clinical practice assessment methods of MNS mainly included theoretical knowledge assessment (88.46%) and the performance of section lectures (82.56%). The assessment personnel were mainly clinical teachers (95.40%) and head nurses (83.51%). The self-assessment of clinical teachers was rated at the medium level about their performance on the postgraduate MNS students ′ clinical teaching. Conclusions:The homogenization and standardization of the construction of MNS clinical teaching base needs to be improved in China. In the field of defining the criteria of clinical teaching teachers, strengthening the construction of clinical faculty, perfecting the clinical teaching plan and evaluation system according to the cultivation objectives and specialist characteristics, and elevating the comprehensive medical education combined with clinical education and college education, further exploration is indispensable.

Complications of nano-knife ablation on locally advanced pancreatic cancer / 中华肝胆外科杂志

Objective:To study the complications of irreversible electroporation (nano-knife) ablation on locally advanced pancreatic cancer, and to analyse the causes of complications and related treatment.Methods:The clinical data of 36 patients with locally advanced pancreatic cancer treated with nano-knife ablation at the Fifth Affiliated Hospital of Zhengzhou University from January 2016 to March 2019 were studied retrospectively. The types and incidence of postoperative complications were analyzed. The complications were classified according to the Clavien-Dindo classification, and the severity of the complications was evaluated.Results:There were 15 patients (41.7%) who developed various degrees of complications, including splenic infarction, atrial fibrillation, portal vein thrombosis, pancreatic fistula, pseudoaneurysm, gastrointestinal bleeding, liver abscess and severe pancreatitis. Among them, 6 patients (16.7%) had grade III complication or above. Three (8.3%) patients with grade Ⅲ complications died of upper gastrointestinal bleeding 3 months after operation.Conclusions:Various complications might occur after nano-knife ablation, with postoperative gastrointestinal and abdominal bleeding being the main complications which resulted in death. Measures which can effectively reduce occurrence of complications need to be studied.

Predictive value of first-trimester ultrasound markers for complicated monochorionic diamniotic twins / 中华围产医学杂志

Objective@#To investigate the value of first-trimester ultrasound parameters in predicting complicated monochorionic diamniotic (MCDA) twins.@*Methods@#In this retrospective study, pregnant women diagnosed as MCDA twins by ultrasound in the First Affiliated Hospital of Sun Yat-sen University from January 2013 to January 2018 were recruited and divided into the following four groups: non-complicated MCDA twins group, twin-twin transfusion syndrome (TTTS) group, selective intrauterine growth restriction (sIUGR) group and twin anemia-polycythemia sequence (TAPS) group. Thickness of nuchal translucency (NT), crown-rump length (CRL), umbilical cord insertion (UCI) and ductus venosus (DV) flow at 11-14 weeks of gestation were recorded. The predictive value for complicated MCDA twins was analyzed using t-test, Chi-square (or Fisher's exact) test, multivariate logistic regression analysis and receiver operating characteristic (ROC) curve.@*Results@#(1) A total of 430 MCDA twin pregnancies were included in this study with 152 in the TTTS group, 142 in the sIUGR group, seven in the TAPS group and 129 in the normal MCDA twins group. No further analysis was performed on the TAPS group due to the small sample size. (2) NT discordance in twins of the TTTS group was significantly greater than that in the normal MCDA twins group[(21.5±16.0)% vs (14.6±13.5)%, t=-3.533, P<0.001]. The area under ROC curve (AUC) of TTTS predicted by NT discordance was 0.649. Stratified analysis showed that TTTS was best predicted when NT discordance was 20% with the sensitivity of 57.9% and specificity of 70.6%. (3) The sIUGR group had greater discordance in CRL and NT and higher UCI discordance than the normal MCDA twins group [NT: (27.8±21.3)% vs (14.6±13.5)%, t=-5.556, P<0.001; CRL: (8.6±6.9)% vs (5.4±4.4)%, t=-3.144, P=0.002; UCI: 47.9% (68/142) vs 13.9% (18/129), χ2=35.929, P<0.001]. The AUC of sIUGR was 0.675 predicted by NT discordance and 0.649 by CRL discordance. Stratified analysis showed that NT discordance of 20% and CRL discordance of 10% were the best prediction for sIUGR with the sensitivity of 53.1% and 34.7% and specificity of 72.1% and 83.8%, respectively. Multivariate logistic regression analysis suggested that UCI discordance was the risk factor for sIUGR (OR=7.165, 95%CI: 2.637-19.472).@*Conclusions@#MCDA twins with NT discordance greater than 20% during early pregnancy are at increased risk for TTTS. CRL discordance greater than 10%, NT discordance greater than 20% and abnormal UCI are risk factors for sIUGR.

Combining irreversible electroporation with a biliary composite stent implantation in treatment of unresectable hilar cholangiocarcinoma / 中华肝胆外科杂志

Objective To evaluate the clinical value of combining irreversible electroporation (IRE) with a biliary composite stent implantation in the treatment of unresectable hilar cholangiocarcinoma.Methods A total of sixteen patients with unresectable hilar cholangiocarcinoma were treated in the Fifth Affiliated Hospital of Zhengzhou University,from April 2016 to July 2018 with combined IRE ablation with a 125I particle biliary composite stent implantation.A comparative analysis was conducted on the clinical data including total bilirubin,ALT,AST,myocardial enzymes before and after surgery.Results All patients underwent successful operation and the hemodynamics were stable during the operations.In 16 patients,the myocardial enzymes increased on the first day after surgery and fell to normal within 5 days.A total of thirteen patients had a progressive reduction of CA19-9,1 patient had no significant change in CA19-9,and 2 patients had CA19-9 in the normal range before and after treatment.Total bilirubin,AST,and ALT decreased gradually after surgery in all the patients.Postoperative complications included biliary bleeding (1 patient),and ascites (1 patient).All patients were able to have the PTCD tube removed after treatment.The median time to PTCD removal was 46 days (range 11 ～ 123 days),and the median catheter-free time before requiring another PTCD tube replacement was 184 days (range 43 ～365 days).Conclusions IRE ablation combined with a biliary composite stent in the treatment of unresectable hilar cholangiocarcinoma was safe.The treatment had good short-term outcomes and it significantly improved the quality of life of the patients.

Predictive value of first-trimester ultrasound markers for complicated monochorionic diamniotic twins / 中华围产医学杂志

Objective To investigate the value of first-trimester ultrasound parameters in predicting complicated monochorionic diamniotic (MCDA) twins. Methods In this retrospective study, pregnant women diagnosed as MCDA twins by ultrasound in the First Affiliated Hospital of Sun Yat-sen University from January 2013 to January 2018 were recruited and divided into the following four groups: non-complicated MCDA twins group, twin-twin transfusion syndrome (TTTS) group, selective intrauterine growth restriction (sIUGR) group and twin anemia-polycythemia sequence (TAPS) group. Thickness of nuchal translucency (NT), crown-rump length (CRL), umbilical cord insertion (UCI) and ductus venosus (DV) flow at 11-14 weeks of gestation were recorded. The predictive value for complicated MCDA twins was analyzed using t-test, Chi-square (or Fisher's exact) test, multivariate logistic regression analysis and receiver operating characteristic (ROC) curve. Results (1) A total of 430 MCDA twin pregnancies were included in this study with 152 in the TTTS group, 142 in the sIUGR group, seven in the TAPS group and 129 in the normal MCDA twins group. No further analysis was performed on the TAPS group due to the small sample size. (2) NT discordance in twins of the TTTS group was significantly greater than that in the normal MCDA twins group[(21.5±16.0)% vs (14.6±13.5)%, t=－3.533, P<0.001]. The area under ROC curve (AUC) of TTTS predicted by NT discordance was 0.649. Stratified analysis showed that TTTS was best predicted when NT discordance was 20% with the sensitivity of 57.9% and specificity of 70.6%. (3) The sIUGR group had greater discordance in CRL and NT and higher UCI discordance than the normal MCDA twins group [NT: (27.8±21.3)% vs (14.6±13.5)%, t=－5.556, P<0.001; CRL: (8.6±6.9)% vs (5.4±4.4)%, t=－3.144, P=0.002; UCI: 47.9% (68/142) vs 13.9% (18/129), χ2=35.929, P<0.001]. The AUC of sIUGR was 0.675 predicted by NT discordance and 0.649 by CRL discordance. Stratified analysis showed that NT discordance of 20% and CRL discordance of 10% were the best prediction for sIUGR with the sensitivity of 53.1% and 34.7% and specificity of 72.1% and 83.8%, respectively. Multivariate logistic regression analysis suggested that UCI discordance was the risk factor for sIUGR ( OR=7.165, 95% CI : 2.637-19.472). Conclusions MCDA twins with NT discordance greater than 20% during early pregnancy are at increased risk for TTTS. CRL discordance greater than 10%, NT discordance greater than 20% and abnormal UCI are risk factors for sIUGR.

Emergency department patient experience: Same location, same provider, different scores by different survey methods / 世界急诊医学杂志（英文）

BACKGROUND@#Recent findings on emergency department (ED) patient experience surveys and concerns for the low response rates challenge the quality and reliability of the survey reports. We assessed the consistency of an ED patient experience survey report and identified the effects of patient demographics on ED patient experiences.@*METHODS@#We conducted a prospective, cross-sectional study at a university-based ED from July to December 2017. We obtained ED patient experience scores from an institutional version (IS) survey and the Press Ganey Associates-distributed survey (PGA). We compared top box scores from the two reports using frequency analysis and performed multivariable logistic regressions to identify associations between IS patient demographics and scores.@*RESULTS@#We obtained 289 PGA and 234 IS responses. The IS reported significant, higher top box scores in doctor-specific patient questions compared to PGA (all four P-values < 0.01). Female, Christian and White patients were more likely to give top box scores (OR 3.07, OR 2.22 and OR 2.41, P-value < 0.05, respectively).@*CONCLUSION@#We found significant differences in ED patient experience scores between the IS and PGA surveys. We recommend that healthcare providers consider patient demographic variables when interpreting ED experience score reports. Multiple survey techniques and distribution methods may be adopted to best capture ED patient experiences.

Preliminary application study of quantitative susceptibility mapping in evaluating the osteoporosis / 中华放射学杂志

Objective To explore the efficacy of quantitative susceptibility mapping (QSM) in the assessment of osteoporosis and the impact factors on the QSM values.Methods A total of 105 volunteers (35 males and 70 females) were recruited in this study.The height,weight,waistline and hipline were measured,and the body mass index was calculated.All the subjects underwent MRI-based QSM and quantitative computed tomography (QCT).The measurement of QSM and QCT values was performed on L3 vertebrae body.According to QCT value,the subjects were divided into three groups (normal,osteopenia and osteoporosis).According to age,the subjects were divided into group I (21-30 years old),group 2 (31-40 years old),group 3 (41-50 years old),group 4 (51-60 years old),and group 5 (＞60 years old).Differences among all groups were compared using one-way ANOVA or Kruskal-Wallis.Results According to QCT value,54 subjects were normal,22 osteopenic and 29 osteoporotic.The QSM value for the subjects with osteoporosis [148.60(109.42,188.81)ppb] was significantly higher than that of normal (P＜0.001)and the osteopenia (P＜0.001).The QSM value for the subjects with osteopenia was significantly higher than the normal (P＜0.001).The coefficient of QSM and BMD was-0.749 (P＜0.001).Multiple linear regression showed age was the independent influence factor for QSM value (r=0.72,P＜0.001),whereas the gender,BMI,waistline and hipline showed no significant difference (P＞0.05).With the increasing of age,the QSM value showed a gradual increasing trend.And there were significant differences of QSM values among the different age groups (P＜0.001).The QSM value of 138.98 (100.37,183.84)ppb for group 5 (＞60 years old) was significantly higher than that of group 1,group 2,and group 3 (P＜0.001).There is no difference between group 5 and group 4 (P＞0.05).The QSM value of 96.62(28.62,143.99)ppb for group 4 (51-60 years old) was significantly higher than that of group 1 and group 2 (P＜0.001).And there was no difference between group 4 and group 3 (P＞0.05).The QSM value of group 1,group 2,and group 3 showed no significant difference (P＞0.05).Conclusions The QSM of bone is feasible in the assessment of osteoporosis and has the potential to be a biomarker providing new insights into osteoporosis.And age is the critical factor affecting QSM value.

Effect of continued nursing support on speech intelligibility and the quality of life in postoperative patients with tongue cancer / 中国实用护理杂志

Objective@#To research and analysis the effect of continued nursing support on speech intelligibility and the quality of life in postoperative patients with tongue cancer.@*Methods@#A total of 80 patients treated in our hospital with tongue cancer from May 2014 to August 2016 were selected and randomly divided into the intervention group and the control group in accordance with the convenience sampling method, 40 cases in each group. All patients received the same health guidance education after discharge according to care routine.At the same time, the patients in the intervention group received the continued nursing support. Intervention effects were observed in two groups by using the Chinese speech intelligibility test table and the University of Washington Quality of Life Questionnaire (UW-QOLv4).@*Results@#One day before the operation, the speech intelligibility (94.8±4.9) scores, the survival quality (1 076.3±51.9) scores in the intervention group compared to the scores (96.0±3.2, 1 084.7±46.5) in the control group,there were no statistical difference (t=-1.297,-0.762, both P>0.05). Two weeks after the operation, there were also no statistical difference (t=1.136,P>0.05) on the speech intelligibility scores between the intervention group (33.7±3.1) and the control group(32.9±3.2). One month,three months and six months after the operation, the scores in the intervention group(61.2±2.7,79.5±4.3,90.9±2.4 respectively) were much higher than that in the control group(49.6±2.4,63.6±3.8, 78.6±3.5) with significant difference (t=20.309,17.524,18.331, all P<0.05).Six months after the operation,the scores in the intervention group(786.4±67.1) were much higher than that in the control group (597.6±58.2) with significant difference(t=13.443,P<0.05).@*Conclusions@#The implementation of continued nursing support can effectively improve speech intelligibility and the quality of postoperative survival in patients with tongue cancer.

Analysis on prevalence of physical fitness and related influencing factors among Chinese Han students aged 13-18 years in 2014 / 中华预防医学杂志

Objective@#To analyze the prevalence of physical fitness among Chinese Han students aged 13-18 years in 2014, and explore related influencing factors.@*Methods@#This study recruited 106 881 Han students aged 13-18 years who had taken physical fitness test from Chinese National Survey on Students' Constitution and Health in 2014. After the exclusion of 1 047 students without complete records of physical fitness test, 105 834 students were included in the final analysis. According to the National Student Physical Health Standard modified in 2014, seven indicators including body mass index, vital capacity, 50-m run, sit-and-reach, standing broad jump, pull-ups/curl-ups and endurance run were tested to calculate the total score of students' physical fitness. Students with score ≥60 were regarded as qualified students. Multivariate non-conditional logistic regression model was used to analyze influencing factors of physical fitness.@*Results@#Among Chinese Han students aged 13-18 years, the total score was 70.1±10.7 and the qualified rate was 83.9% (n=88 813). Boys (83.5% (44 197/52 910)) had a lower qualified rate of physical fitness than girls (84.3% (44 616/52 924)) (P<0.001), and 13-15 age group (86.5% (46 255/53 465)) was higher than the 16–18 age group (81.3% (42 558/52 369)) (P<0.001). Except for 16–18-year-old boys from central region, normal body mass index, eastern region, good socioeconomic status, enough PE class, exercise time ≥1 h/d, homework time ≥2 h/d, TV time <1 h/d were all related to high qualified rates of physical fitness (P<0.05).@*Conclusion@#Chinese Han students aged 13-18 years were in good physical condition. The qualified rates of physical fitness were significantly different by gender and age groups. Nutritional status, region, socioeconomic status, PE class, exercise time per day, homework time per day, and TV time per day were related factors of physical fitness.

The association between the malnutrition and blood pressure in Chinese Han students aged 7-18 years in 2014 / 中华预防医学杂志

Objective@#This study aimed to explore the association between malnutrition and the level of blood pressure (BP) as well as elevated BP (EBP) in Han students aged 7 to 18 years in China.@*Methods@#170 037 subjects with normal nutritional status and malnutrition were enrolled in this study from 2014 Chinese National Surveys on Students' Constitution and Health with a multi-stage stratified cluster random sampling framework covering 31 provinces, autonomous regions and municipalities after the exclusion of 44 317 overweight and obese students. According to the standard of "Screening Standard for Malnutrition of School-age Children and Adolescents" (WS/T456-2014), the nutritional status of children were classified into two categories, normal nutritional status and malnutrition containing stunting, mild wasting and moderate severe wasting. The level of BP and prevalence of EBP were compared between students with normal nutritional status and malnutrition. The multivariate logistic regression model was used to analyze the association between malnutrition and EBP.@*Results@#The levels of systolic BP (SBP) and diastolic BP (DBP) in Chinese Han students aged 7-18 years who were non-overweight and non-obesity status were (103.4±12.3) and (64.7±9.5) mmHg (1 mmHg=0.133 kPa), respectively. The prevalence of EBP, systolic EBP and diastolic EBP in Chinese Han malnourished students (N=21 012) were 3.1% (n=649), 1.5% (n=324) and 2.1% (n=445), respectively, which was significantly lower than those (N=148 320) with normal nutritional status (4.5% (n=6 707), 2.6% (n=3 872) and 2.7% (n=3 959)), and the corresponding differences were statistically significant (P<0.05). The OR (95%CI) between malnutrition and EBP was 0.68 (0.62-0.73), which were 0.65 (0.58-0.72) and 0.68 (0.60-0.77) for boys and girls. The OR (95%CI) between EBP and stunting as well as mild wasting and moderate severe wasting were 0.69 (0.62-0.77), 0.63 (0.55-0.72) and 0.79 (0.60-1.05), respectively.@*Conclusion@#The level of BP and prevalence of EBP in Chinese Han students with malnutrition were lower than those with normal nutritional status. The negative correlation existed between malnutrition and EBP in Chinese Han students aged 7 to 18 years.

Analysis of nutritional status among Chinese students of five ethnic minorities aged 7-18 years in 2014 / 中华预防医学杂志

Objective@#To understand the nutritional status among Chinese students of five ethnic minorities aged 7-18 years.@*Methods@#Chinese National Survey on Students Constitution and Health in 2014 applied multi-stage stratified cluster random sampling, including 214 354 students from 31 province of China mainland. 73 students whose height or weight information were missing, were excluded. 25 968 minority students aged 7-18 years from Inner Mongolia Autonomous Region, Ningxia Hui Autonomous Region, Xinjiang Uygur Autonomous Region, Guangxi Zhuang Autonomous Region and Jilin Provinces were included for data analysis, including Mongolian (n=5 107), Hui (n=5 308), Uygur (n=5 740), Zhuang (n=5 267) and Korean (n=4 546) students. According to the BMI standard of Working Group on Obesity in China (WGOC) and the new students' health standard of Screening Standard for Malnutrition of School-age Children and Adolescents (WS/T 456-2014) , students were defined as wasting, normal weight, overweight and obesity groups and the nutritional status in different minorities and other characteristics was described and analyszed.@*Results@#The prevalences of wasting in Zhuang, Hui, Uygur, Korean and Mongolian students were 6.1% (318/5 267), 5.1% (266/5 308), 3.2% (187/5 740), 2.6% (116/4 546) and 1.3% (65/5 107) in descending order (χ2=212.60, P<0.001), respectively. The prevalences of overweight in Korean, Mongolian, Hui, Uygur and Zhuang students were 15.2% (686/4 546), 13.1% (669/5 107), 10.3% (549/5 308), 7.8% (446/5 740) and 7.8% (413/5 267) in descending order (χ2=220.80, P<0.001), respectively. The prevalences of obesity in Korean, Mongolian, Hui, Zhuang and Uygur students were 15.3% (695/4 546), 9.5% (488/5 107), 5.7% (304/5 308), 4.6% (242/5 267) and 3.6% (206/5 740) in descending order (χ2=647.02, P<0.001), respectively. The prevalences of wasting in Mongolian, Uygur and Korean rural students were 1.7% (44/2 623), 3.9% (113/2 868) and 3.4% (74/2 154), higher than urban students (all P values <0.05) which were 0.8% (21/2 484), 2.6% (74/2 872) and 1.8% (42/2 392) in Mongolian, Uygur and Korean students. The prevalence of obesity in Mongolian, Hui, Uygur, Zhuang and Korean urban students were 10.8% (269/2 484), 7.6% (193/2 554), 4.1% (117/2 872), 5.9% (153/2 601) and 16.6% (396/2 392), higher than rural students (all P values <0.05) which were 8.3% (219/2 623), 4.0% (111/2 754), 3.1% (89/2 868), 3.3% (89/2 666) and 13.9% (299/2 154) in Mongolian, Hui, Uygur, Zhuang and Korean students. The prevalence of obesity in Hui, Zhuang and Korean boys were 7.2% (188/2 570), 6.0% (157/2 628) and 17.2% (394/2 282), respectively, higher than that of girls which were 4.2% (116/2 738), 3.3% (85/2 639) and 13.3% (301/2 264) (all P values <0.05).@*Conclusion@#The prevalence of wasting, overweight and obesity varied by ethnic minorities in mainland China. The prevalence of overweight and obesity appears higher among mongolian and Korean students, while the prevalence of wasting was higher in Zhuang students.

Effect of the self-efficacy rehabilitation of patient with total knee arthroplasty on the first time of ambulation after operation / 中国实用护理杂志

Objective To explore the effect of the rehabilitation self-efficacy of patient with total knee arthroplasty on the first time of ambulation after operation.Methods Totally 110 patients undergoing total knee arthroplasty were recruited,they were investigated with self-designed general information and disease situation questionnaire and recorded the first time of ambulation.The self-efficacy was measured by the Self-Efficacy for Rehabilitation outcome scale(SER).Results The earliest time of ambulation was 7.5 hours after surgery.The latest time of ambulation was 54.0 hours after surgery.The median time of the first ambulation was 46.0 h.The mean score of self-efficacy for rehabilitation therapy exercises was (28.58 ± 9.18) points,and the mean score of self-efficacy in overcoming barriers was (43.07 ± 11.04) points,and the mean score of SER was (71.65 ± 18.47) points.The total score of self-efficacy for rehabilitation therapy exercises,self-efficacy in overcoming barriers,and the score of SER were negatively correlated with the first time of ambulation (r=-0.442,-0.299,-0.399,P＜ 0.01).The self-efficacy of rehabilitation was one of the influencing factors of patient's first time of ambulation(P ＜ 0.05),which explained 9.7％ of total variance of early ambulation of patients with total knee arthroplasty.Conclusions The self-efficacy of rehabilitation after total knee arthroplasty was significantly correlated with the first time of ambulation,and the higher self-efficacy of rehabilitation,the earlier the first time of ambulation.The self-efficacy of rehabilitation was one of the important factors that affect the first time of the patient's ambulation after total knee arthroplasty.