Analysis of accreditation results and development strategies of tertiary hospitals in Jiangsu province from 2018 to 2020 / 中华医院管理杂志

As an important measure starting for hospital management, hospital accreditation can effectively guide hospitals to improve their comprehensive service capabilities and management level. The accreditation results of 38 tertiary general hospitals in Jiangsu province from 2018 to 2020 showed that there were weaknesses existing in the development of hospitals, including the radiosity and influence of tertiary hospitals, patient service mode, construction of medical technology capabilities and disciplines, medical quality and safety, nursing quality management and specialized nursing, and information construction. The author suggested that hospitals should return to functional positioning, improve the service quality, strengthen construction of hospital disciplines and technical projects, consolidate the foundation of quality and safety management, improve the level of information technology construction, for references for promoting the high-quality sustainable development of tertiary general hospitals.

The Etiological Study of Three Hunter Syndrome Families in Southern China / 中山大学学报(医学科学版)

ObjectiveTo reveal the molecular pathogenesis of Hunter syndrome in three families in southern China and to clarify the correlation between phenotype and genotype， so as to lay a foundation for future prenatal or preimplantation genetic diagnosis. MethodsOn the basis of initial clinical diagnosis and pedigree analysis， qualitative detection of glycosaminoglycans in urine was performed first， and then anticoagulant blood samples were collected from the children and their relatives. DNA was extracted and the IDS gene sequence was analyzed by PCR and Sanger sequencing. Various methods such as RT-PCR and bioinformatics analysis were used to identify the pathogenicity of the new variants. ResultsThe urine test results of the patients in the three families were all strongly positive（++）. Probands were all male， with hemizygous mutations in IDS gene from their mothers， and the mutation sites were c.615_622delCATACAGT， c.847_848delGT and IVS7 ds+1 G>A， respectively. The cross-species conservation analysis showed that the amino acid of IDS gene mutation site was highly conserved during species evolution. Compared with the normal protein， mutant proteins exhibited significant differences in the predicted results of advanced structure. The variants identified in the three families were classified as pathogenic by ACMG criteria. ConclusionsThe three probands were diagnosed with Hunter syndrome. The c.615_622del（p.Il206Valfs*18）， c.847_848del（p.Val283Alafs*57） and IVS7 ds+1 G>A （p.G336Dfs*12） of IDS gene are all novel pathogenic mutations， which are the underlying causes of morbidity in children. This study has further enriched the mutation spectrum of IDS gene.

Influencing Factors and Prediction Model of Performance of Needle Visualization in Fine Needle Aspiration of Thyroid Nodules / 中国医学科学院学报

Objective To investigate the influencing factors and establish a model predicting the performance of needle visualization in fine-needle aspiration (FNA) of thyroid nodules. Methods This study prospectively included 175 patients who underwent FNA of thyroid nodules in the Department of Ultrasound in China-Japan Friendship Hospital and compared the display of the needle tips in the examination of 199 thyroid nodules before and after the application of needle visualization.We recorded the location,the positional relationship with thyroid capsule,ultrasonic characteristics,and the distribution of the soft tissue strip structure at the puncture site of the nodules with unclear needle tips display before using needle visualization.Furthermore,according to the thyroid imaging reporting and data system proposed by the American College of Radiology,we graded the risk of the nodules.Lasso-Logistic regression was employed to screen out the factors influencing the performance of needle visualization and establish a nomogram for prediction. Results The needle tips were not clearly displayed in the examination of 135 (67.8%) and 53 (26.6%) nodules before and after the application of needle visualization,respectively,which showed a significant difference (P<0.001).Based on the positional relationship between the nodule and capsule,anteroposterior/transverse diameter (A/T) ratio,blood supply,and the distribution of subcutaneous strip structure at the puncture site,a nomogram was established to predict the probability of unclear display of the needle tips after application of needle visualization.The C-index of the prediction model was 0.75 (95%CI=0.67-0.84) and the area under the receiver operating characteristic curve was 0.72.The calibration curve confirmed the appreciable reliability of the prediction model,with the C-index of 0.70 in internal validation. Conclusions Needle visualization can improve the display of the needle tip in ultrasound-guided FNA of thyroid nodules.The nomogram established based on ultrasound features such as the positional relationship between the nodule and capsule,A/T ratio,blood supply,and the distribution of subcutaneous strip structure at the puncture site can predict whether needle visualization is suitable for the examination of nodules.

Nomogram-Based Prediction of Risk of Cervical Lymph Node Metastasis in Differentiated Thyroid Carcinoma / 中国医学科学院学报

Objective To establish a nomogram for predicting the risk of cervical lymph node metastasis in differentiated thyroid carcinoma (DTC). Methods The patients with complete clinical data of DTC and cervical lymph node ultrasound and diagnosed based on pathological evidence from January 2019 to December 2021 were assigned into a training group (n=444) and a validation group (n=125).Lasso regression was performed to screen the data with differences between groups,and multivariate Logistic regression to establish a prediction model with the factors screened out by Lasso regression.C-index and calibration chart were employed to evaluate the prediction performance of the established model. Results The predictive factors for establishing the model were lymph node short diameter≥0.5 cm,long-to-short-axis ratio<2,disappearance of lymph node hilum,cystic transformation,hyperechogenicity,calcification,and abnormal blood flow (all P<0.001).The established model demonstrated a good discriminative ability,with the C index of 0.938 (95%CI=0.926-0.961) in the training group. Conclusion The nomogram established based on the ultrasound image features of cervical lymph nodes in DTC can accurately predict the risk of cervical lymph node metastasis in DTC.

Application of limiting antigen avidity enzyme immunoassay for estimating HIV-1 incidence in men who have sex with men / 中华流行病学杂志

Objective: To estimate the incidence of HIV-1 infection in men who have sex with men (MSM) in key areas of China through HIV-1 limiting antigen avidity enzyme immunoassay (LAg-Avidity EIA), analyze the deviation from the actual results and identify influencing factors, and provided reference for improving the accuracy of estimation results. Methods: Based on the principle of the cohort randomized study design, 20 cities were selected in China based on population size and the number of HIV-positive MSM. The sample size was estimated to be 700 according to the HIV-1 infection rate in MSM. MSM mobile phone app. was used to establish a detection appointment and questionnaire system, and the baseline cross-sectional survey was conducted from April to November 2019. LAg-Avidity EIA was used to identify the recent infected samples. The incidence of HIV-1 infection was calculated and then adjusted based on the estimation formula designed by WHO. The influencing factors were identified by analyzing the sample collection and detection processes. Results: Among the 10 650 blood samples from the participants, 799 were HIV-positive in initial screening, in which 198 samples (24.78%) missed during confirmation test. Only 621 samples were received by the laboratory. After excluding misreported samples, 520 samples were qualified for testing. A total of 155 samples were eventually determined as recent infection through LAg-Avidity EIA; Based on the estimation formula , the incidence of HIV-1 infection in MSM in 20 cities was 4.06% (95%CI:3.27%-4.85%), it increased to 5.53% (95%CI: 4.45%-6.60%)after the adjusting for sample missing rate. When the sample missing rate and misreporting rate were both adjusted, the incidence of HIV-1 infection in the MSM increased to 5.66% (95%CI:4.67%-6.65%). The actual incidence of HIV-1 infection in MSM in the 20 cities might be between 4.06% and 5.66%. Conclusions: Sample missing and misreporting might cause the deviation of the estimation of HIV-1 infection incidence. It is important to ensure the sample source and the quality of sample collection and detection to reduce the deviation in the estimation of HIV-1 infection incidence.

Progress of reversible parkinsonism / 中华神经科杂志

Parkinsonism is a clinical syndrome caused by many reasons, mainly manifested as bradykinesia, stiffness, static tremor and postural instability. Common disease development patterns include occult onset, gradual development, and little natural remission. However, clinically there are some Parkinsonism that will improve, naturally alleviate or "cure", called reversible parkinsonism (RP). By searching the relevant literature, RP was classified into 12 different types: drugs induced, poisoning induced, infection induced, intracranial vascular induced, structural encephalopathy related, changes in intracranial pressure related, imbalance of internal environment induced, visceral diseases related, alcohol withdrawal related, surgery related, immunization and radiotherapy induced RP. This article aims to provide clinicians with more ideas for the clinical diagnosis and treatment of parkinsonism, so as to promote clinicians to make reasonable identification and diagnosis and treatment of parkinsonism as soon as possible.

Research progress of the regulation of cochlear sensitivity to noise by circadian rhythm / 生理学报

High level noise can damage cochlear hair cells, auditory nerve and synaptic connections between cochlear hair cells and auditory nerve, resulting in noise-induced hearing loss (NIHL). Recent studies have shown that animal cochleae have circadian rhythm, which makes them different in sensitivity to noise throughout the day. Cochlear circadian rhythm has a certain relationship with brain-derived neurotrophic factor and glucocorticoids, which affects the degree of hearing loss after exposure to noise. In this review, we summarize the research progress of the regulation of cochlear sensitivity to noise by circadian rhythm and prospect the future research direction.

Research advances in intraductal papillary mucinous neoplasm of the bile tract / 临床肝胆病杂志

Intraductal papillary mucinous neoplasm of the bile duct (IPMN-B) is a special type of tumor occurring in the biliary system, with no specific clinical manifestations and imaging findings, and thus it is difficult to diagnose before surgery. It is often considered when a large amount of mucus is found in the bile duct during surgery and then it is forced to change the surgical plan. Clinicians lack an understanding of this disease due to its low incidence rate. This article reviews the recent research advances in the etiology and classification, clinical features, differential diagnosis, treatment, and prognosis of IPMN-B, so as to improve the clinical diagnosis and treatment of IPMN-B among clinicians.

Tripodalsporormielones A-C, unprecedented cage-like polyketides with complex polyvdent bridged and fused ring systems

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Effects of oxygen-enriched negative pressure wound therapy in improving wound microenvironment to tissue proliferation and vascularization / 医学研究生学报

ObjectiveIt is indefinited that oxygen-enriched negative pressure wound therapy, namely negative pressure wound therapy combined with topical oxygen therapy (NPWT+TOT), improve the effects of wound microenvironment in tissue proliferation and vascularization. The objective is to discuss effects of oxygen-enriched negative pressure wound therapy in improving wound microenvironment to tissue proliferation and vascularization.MethodsTo select sixty-four patients in the outpatient wound care center of the eastern theater general hospital from January to October, 2019, which were randomly divided into the experimental group (NPWT+TOT) and the control group (NPWT), 32 cases in each group. The patients were treated with oxygen-enriched negative pressure wound and negative pressure wound respectively for 2 weeks to observe the changes of wound temperature and PH before and during intervention. Bacterial culture and immunohistochemical staining which were made from wound secreta and wound bed tissues to observe bacterial culture results, tissue proliferation activity and microvascular density before intervention and 14 days after intervention. After the intervention, the patients were treated by standard wet therapy and followed up to wound healing or 3 months after the intervention to observe the wound healing rate and wound healing time.ResultsAfter two weeks' continuous intervention, wound temperature of patients increased and PH value decreased significantly between the experimental group and the control group. Meanwhile, the intervention group was more effective, and there were significant differences between the two groups (P<0.05). The positive rate of bacterial culture after intervention in the experimental group and the control group was 26.67% and 41.38% respectively, with no statistically significant difference (P=0.233). Compared with the control group, the increase of tissue activity and microvascular density in the experimental group was more significant (P<0.05). After three months' follow-up, the wound healing rate of the experimental group was increased by 12.5% compared with the control group, and the average wound healing time was shortened by 9.2 days.ConclusionOxygen-enriched negative pressure wound therapy can improve wound microenvironment, reduce the positive rate of wound bacterial culture, improve the proliferation activity of wound tissue and degree of vascularization, and promote wound healing.

Two cases of familial benign pemphigus treated with botulinum toxin type A / 中华皮肤科杂志

Botulinum toxin type A was firstly used to treat two patients with familial benign pemphigus, who showed poor response to conventional therapies. Case 1, a 64-year-old male patient, presented with erythema and erosions on bilateral axillary and inguinal regions for 2 years, and was injected with botulinum toxin type A at a dose of 50 U in the right axillary fossa and right groin separately. Case 2, a 33-year-old female patient, presented with erythema and blisters on bilateral axillary and inguinal regions and the right waist for 9 years, and was injected with botulinum toxin type A at a dose of 25 U in the left axillary fossa, right waist and bilateral groins separately. After the injection of botulinum toxin type A, sweating was inhibited in the 2 patients within 1 week, and skin lesions were gradually attenuated within 2 weeks. One month after the injection, erythema and erosions on bilateral axillary and inguinal regions mostly regressed in the case 1, and no recurrence was observed during 18-month follow-up. Six weeks after the injection, most of the skin lesions regressed in the case 2, only patchy hyperpigmentation was observed, and no obvious new lesions occurred. A few lesions recurred in the case 2 during 10-month follow-up, but were attenuated after the treatment with topical glucocorticoids.

Neuroprotective effect of vascular endothelial growth factor / 中华实验眼科杂志

Vascular endothelial growth factor (VEGF),also known as vascular permeability factor,can promote the proliferation and migration of vascular endothelial cells,and enhance vascular permeability.In addition,VEGF family is also related to lymphatic vessel formation,inflammatory response,hematopoiesis and neuroprotective effect.Under the circumstances of ischemia,hypoxia and oxidative stress,VEGF can exert neuroprotective effect by increasing tissue perfusion,inhibiting cell apoptosis and stimulating neurogenesis.Therefore,therapeutic effect of VEGF in neurological diseases,such as neurodegenerative diseases and stroke has increasingly received considerable attention.On the other hand,anti-VEGF therapy for ocular pathologic neovascular diseases may lead to corresponding adverse effect.In this review,the mechanism of neuroprotective effect of VEGF and its roles in neurological diseases and ocular diseases were discussed.

Neuroprotective effect of vascular endothelial growth factor / 中华实验眼科杂志

Vascular endothelial growth factor(VEGF), also known as vascular permeability factor, can promote the proliferation and migration of vascular endothelial cells, and enhance vascular permeability.In addition, VEGF family is also related to lymphatic vessel formation, inflammatory response, hematopoiesis and neuroprotective effect.Under the circumstances of ischemia, hypoxia and oxidative stress, VEGF can exert neuroprotective effect by increasing tissue perfusion, inhibiting cell apoptosis and stimulating neurogenesis.Therefore, therapeutic effect of VEGF in neurological diseases, such as neurodegenerative diseases and stroke has increasingly received considerable attention.On the other hand, anti-VEGF therapy for ocular pathologic neovascular diseases may lead to corresponding adverse effect.In this review, the mechanism of neuroprotective effect of VEGF and its roles in neurological diseases and ocular diseases were discussed.

Application value of ultrasound in the assessment of local advanced thyroid carcinoma / 中国实用外科杂志

Local advanced thyroid carcinoma is difficult to treat in clinic.Ultrasound has the advantages of high resolution,accurate positioning and real-time imaging.It is the preferred imaging method for diagnosis,follow-up and evaluation of thyroid carcinoma patients. Ultrasound provides the size and location of the lesion and whether the invasion of the surrounding organs and cervical lymph node metastasis,which can real-time monitor disease progression.In addition,ultrasound-guided radiofrequency ablation can provide a definitive therapeutic effect for patients with advanced thyroid cancer who cannot undergo surgery.

Application of Ultrasonography in the Diagnosis of Medullary Thyroid Cancer / 中国医学科学院学报

Despite its low incidence,medullary thyroid carcinoma(MTC)is featured by its fast progression and poor prognosis.Early diagnosis and treatment is therefore particularly important.As a convenient and non-invasive diagnostic tool,ultrasound plays a key role in the diagnosis and follow-up of MTC.In recent years,the application of conventional ultrasound,ultrasonic elastography,and ultrasound-guided fine needle aspiration biopsy has dramatically improved the diagnostic accuracy of MTC.

Protective effect of against oxidative stress in neonatal mice with necrotizing enterocolitis / 南方医科大学学报

OBJECTIVE@#To investigate the protective effect of DSM17938 strain against oxidative stress in a neonatal mouse model of necrotizing enterocolitis (NEC) and explore the possible mechanism.@*METHODS@#Ninety-six 10-day-old neonatal C57BL/6J mice were equally randomized into control group, NEC group, and NEC+ group. The pathological changes of the ileocecal intestinal tissue were evaluated with HE staining and double-blind pathological scoring. The mRNA and protein expressions of tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) in the intestinal tissues were detected using quantitative real-time PCR and ELISA, respectively. Colorimetric assays were used to determine the activity of superoxide dismutase (SOD) and its inhibition rate, malondialdehyde (MDA), glutathione (GSH), oxidized glutathione (GSSG), and GSSG/ GSH ratio.@*RESULTS@#Compared with those in the control group, the neonatal mice in NEC group showed significant weight loss ( 0.05).@*CONCLUSIONS@# DSM17938 can offer protection against NEC in mice by reducing oxidative stress and increasing antioxidant capacity of the intestinal tissue to suppress intestinal inflammations.

Recovery time and risk factors of childhood coagulopathy caused by rodenticide poisoning / 中华实用儿科临床杂志

Objective@#To explore the recovery time and risk factors of coagulopathy caused by rodenticide poisoning through analyzing and following up the confirmed cases, and to provide more useful guidance information for the clinic practice.@*Methods@#A total of 96 cases with coagulation dysfunction caused by anticoagulant rodenticide poiso-ning in Children′s Hospital, Chongqing Medical University from January 2014 to December 2016, were analyzed retrospectively.The recovery time of coagulation function and the relationship between recovery time and drug involved way, dysfunction organs and poison concentration were studied respectively.@*Results@#(1) A total of 96 patients were hospitalized because of severe coagulopathy caused by the poisoning of second generation anticoagulant rodenticide.Brodifacoum was detected from 33 blood samples and the median concentration was 364 μg/L (55-4 654 μg/L). Bromadiolone was detected from 7 blood samples and the median concentration was 130 μg/L (18-652 μg/L). Brodifacoum and Bromadiolone were both detected from 8 cases and the median concentration was 741 μg/L (63-6 000 μg/L) and 11 μg/L (3-3 694 μg/L), respectively.(2) A total of 57 cases of the patients were successfully followed up.A total of 18 cases were confirmed with oral poisoning, 16 cases with dermal poisoning, while 23 cases denied any involved ways of poisoning, and 7 cases had organs dysfunction.The follow-up time was 12-54 months.All the hospitalized patients were given specific antidote Vitamin K treatment and recovered successfully without any sequelae.(3) The median recovery time of coagulopathy caused by rodenticide poisoning was 2.5 months.(4) The recovery time of coagulation function was positively correlated with the plasma concentration of Brodifacoum(r=0.619, P<0.01). (5) There was no significant correlation between recovery time and organ dysfunction or drug involved ways of poisoning involvement (all P>0.05).@*Conclusions@#The recovery time of coagulation dysfunction caused by anticoagulant rodenticide in children is much longer.The higher the concentration of Brodifacoum poison is, the longer the recovery time.Enough supplementation course of Vitamin K should be given according to the follow-up of coagulation function.

Prediction model for distant metastasis of breast cancer based on magnetic resonance imaging / 中国肿瘤临床

Objective: To establish a prediction model for the distant metastasis of breast cancer based on qualitative magnetic reso-nance imaging (MRI) parameters. Methods: A retrospective analysis of 3,032 patients with breast MRI from January 2011 to Decem-ber 2016 in Tianjin Medical University Cancer Institute and Hospital was conducted. After the confirmation of invasive breast cancer, the subjects were divided in 2 groups: metastasis and metastasis-free. A total of 93 patients were included in the metastasis group, and 186 patients without the presence of distant metastasis in the metastasis-free group. We analyzed the correlation between breast cancer molecular subtypes and distant metastasis in the metastasis group. Univariate and Logistic regression analyses of qualitative MRI features were performed for the groups. Subsequently, we used the results to establish prediction models. Results: The results showed that hormone receptor-positive tumors (Luminal type) had a greater tendency to develop bone metastasis in the metastasis group. Triple-negative tumors showed a greater tendency to develop lung metastasis. Human epidermal growth factor receptor 2 gene overexpression cases were more likely to develop liver metastasis. The results of the univariate analysis showed that the type of le-sion, multifocality or multicentricity of the cancer, T1-weighted signal uniformity, T2-weighted signal uniformity, and tumor size were statistically different between the groups (P<0.05). The results of the logistic regression analysis showed that the type of lesion, multi-focality or multicentricity of the cancer, T2-weighted signal uniformity, and tumor size were independent predictors of distant metasta-sis. Based on select independent predictors, we established a prediction model for the distant visceral metastasis of breast cancer. The accuracy, area under the curve, sensitivity, and specificity of the model were 82.8%, 0.801, 85.7%, and 75.0%, respectively. Conclu-sions: The prediction model based on the clinical pathology and MRI features established in this study can predict the distant metasta-sis of breast cancer.

Problems and challenges of anti-vascular endothelial growth factor therapy for ocular neovescularization diseases / 中华实验眼科杂志

Anti-vascular endothelial growth factor (VEGF) therapy is a major strategy for treating ocular neovascular diseases nowadays.It has revolutionarily improved the vision of many patients since its emergence.However,VEGF is essentially a protective growth factor that is compensatorily produced by human body.In the anti-VEGF treatment of the diseases,the physiological effects of VEGF are also inhibited,which may result in some related problems,such as retinal atrophy,retinal pigment epithelium (RPE) tears,systemic adverse effects,and so on.Retinal atrophy has become one of the major causes of visual loss in the late stage of the treatment.The specific mechanism underlying them is not completely known,we should pay enough attention to them.How to improve the anti-VEGF treatment strategy in order to reduce the incidence of these problems will be a great challenge.

Effect of intracranial Cryptococcus neoformans infection on the function of efflux transporter breast cancer-resistance protein / 解放军医学杂志

Objective To explore the effect of intracranial Cryptococcus neoformans (Cr.neoformans) infection on the function of fluconazole transport by breast cancer-resistance protein (BCRP),a kind of efflux transporter on the blood-brain barrier (BBB).Methods Twenty-four male Sprague-Dawley rats were randomly divided into 4 groups (6 each):normal rats received 20mg/kg fluconazole by intravenous injection (Group A),normal rats received 20mg/kg fluconazole with co-administration of pantoprazole (a kind of BCRP inhibitor) by intravenous injection (Group B),rats with intracranial Cr.neoformans infection received 20mg/kg fluconazole (Group C),and infected rats received 20mg/kg fluconazole with co-administration of pantoprazole (Group D).Microdialysis probes were implanted into the rats' striatum to continuously collect brain extracellular fluid (ECF) after the intravenous infusion of fluconazole with or without BCRP inhibitor pantoprazole.High-performance liquid chromatography (HPLC) was applied to measure the fluconazole concentrations in blood and brain ECF.The area under the concentration-time curves of fluconazole and the penetration of fluconazole passing though BBB were then calculated.Results Meningoencephalitis rat model was successfully established by intracerebral inoculation of Cr.neoformans.The infection significantly increased the penetration of fluconazole passing through BBB (P＜0.05).Pantoprazole did not alter the distribution of fluconazole in normal rat's brain,but significantly increased the penetration of fluconazole passing through BBB of the infected rats (P＜0.05).Conclusion Cr.neoformans infection can reduce the BBB resistance to fluconazole,and induce the efflux transport of fluconazole from the brain ECF back into the blood by BCRP.