Timing of antibiotic prophylaxis in term prelabor rupture of membranes: A retrospective cohort study using propensity-score matching.

OBJECTIVE: To assess whether earlier administration of antibiotic prophylaxis after prelabor rupture of membranes (PROM) at term would decrease the incidence of maternal and neonatal infections. METHODS: This is a retrospective cohort study comparing women with term PROM who were initiated antibiotic prophylaxis within or after 6 h, and within or after 12 h from PROM to delivery during January 2019 to December 2021. Women with term PROM receiving cephalosporin and without contraindications to vaginal delivery or confirmed or suspected infection were included in the study. The primary outcome was puerperal infection, which refers to the reproductive tract infection occurring within 42 days of delivery. The type of pharmacoeconomic evaluation was selected based on the results of compared effectiveness between the early group and the late group. Propensity-score matching (PSM) was used to adjust confounding. Subgroup and sensitivity analyses were used to verify the robustness of results. RESULTS: We enrolled 5353 women with term PROM, including 4331 initiated with antibiotic within 6 h, 1022 after 6 h, 5077 within 12 h, and 276 after 12 h. After PSM, no significant difference was observed in the baseline characteristics of the groups. There was no statistical difference between antibiotic use within 6 h and after 6 h, or within 12 h and after 12 h, in puerperal infection (4.6% vs. 4.3%, P = 0.826; 2.9% vs. 4.6%, P = 0.471, respectively), total maternal infection, neonatal sepsis, and total neonatal infection. Cost-minimization analysis showed there was no significant difference between antibiotic use within 6 h and after 6 h, or within 12 h and after 12 h, in direct medical costs. CONCLUSION: This study showed that there was no statistical difference in the efficacy and economy of antibiotic prophylaxis used within 6-12 h after rupture of membranes versus after 6-12 h in women with term PROM.

Drug safety signal detection in a regional healthcare database using the tree-based scan statistic and comparison to 3 other mining methods.

AIMS: To evaluate and compare the relative performance of the tree-based scan statistic (TreeScan) with the crude cohort study, Bayesian confidence propagation neural network (BCPNN) and Gamma Poisson Shrinker (GPS) in detecting statin-related adverse events (AEs) in an electronic healthcare database. METHODS: Data from a Chinese healthcare database from 2010 to 2016 were evaluated. We identified statin users based on prescription information in their out-/in-patient records, and AEs were defined according to the ICD-10 codes in patients' diagnosis records. TreeScan was applied to detect AE signals related to statin use and was compared with 3 other methods based on sensitivity, specificity, positive predictive value, negative predictive value, accuracy, the Youden index, area under the precision-recall curve and the area under the receiver operating characteristic curve. RESULTS: A total of 224 187 patients were enrolled and divided into 85 758 statin users and 138 429 nonusers. TreeScan generated 29 positive signals, of which 9 were known AEs. The sensitivities of TreeScan, BCPNN and GPS were all 69.2%, which was higher than that of the crude cohort study (46%). The specificity (82.3%), positive predictive value (31.0%), negative predictive value (95.9%), accuracy (81.0%), Youden index (51.5%) and area under the receiver operating characteristic curve (75.8%) of TreeScan were the highest among the 4 methods. CONCLUSION: TreeScan outperformed the crude cohort, BCPNN and GPS in detecting statin-related AEs in an electronic healthcare database. Therefore, it can be used as a complementary tool for other signal detection methods in drug safety surveillance.

Genetic diversity of mitochondrial cytochrome b gene of Taenia asiatica in Dali Bai Autonomous Prefecture, Yunnan Province / 中华地方病学杂志

Objective:In order to investigate the genetic diversity of mitochondrial cytochrome b (Cytb) gene of Taenia asiatica ( T. asiatica) in Dali Bai Autonomous Prefecture (Dali Prefecture), Yunnan Province. Methods:From May 2019 to August 2021, a total of 131 samples of Taenia were collected from patients admitted to the Dali Prefecture Institute of Schistosomiasis Control, involving five locations (i.e., five groups), including Dali City (58 samples), Weishan Yi and Hui Autonomous County (Weishan County, 14 samples), Midu County (18 samples), Yangbi Yi Autonomous County (Yangbi County, 24 samples) and Eryuan County (17 samples). Primers were designed based on mitochondrial Cytb gene sequence, and part of the Cytb gene sequence was amplified by PCR, then sequenced and homology comparisons were performed. MEGA 7.0 and DNASP 5.10.01 were used to analyze the measured sequence, and data such as base composition, genetic distance, genetic diversity parameters, genetic differentiation index and gene flow were obtained. Results:The amplified fragments of Cytb gene in 131 samples of Taenia were 235 bp. After homology comparisons, they were all T. asiatica. The average contents of A, T, G and C bases were 23.8%, 42.3%, 24.0% and 9.9%, respectively. Of the 131 samples of T. asiatica, 12 haplotypes were defined. The haplotype diversity and nucleic acid diversity were 0.295 9 and 0.006 0, respectively. The ranges of genetic differentiation index and gene flow among the five groups were-0.053 00 to 0.050 40 and 4.710 31 to 162.087 66, respectively. The genetic distance between the five groups ranged from 0.003 5 to 0.009 0, of which the genetic distance between Midu County and Weishan County was the largest, and the genetic distance between Dali City and Yangbi County was the smallest. Conclusions:The mitochondrial Cytb gene of T. asiatica in Dali Prefecture has rich genetic diversity. There is frequent gene exchange among the five groups, and no significant genetic differentiation has been formed.

Predictive factors of upstaging to stage T3a in patients with clinical stage T1 renal cancer / 现代泌尿外科杂志

【Objective】 To investigate the predictive factors of clinical T1 (cT1) stage renal cell carcinoma (RCC) escalation to T3a (pT3a), hoping to identify high-risk patients with occult pT3a features. 【Methods】 A total of 666 patients with cT1 RCC who underwent radical or partial nephrectomy were involved and divided into upstaging group and non-upstaging group. The independent predictive factors of cT1 to pT3a stage were determined with univariate and multivariate logistic regression analyses. A model was established. The area under the receiver operator characteristic (ROC) curve (AUC) and calibration plot were used to assess the predictive model’s discrimination and calibration. 【Results】 The upgrading rate was 11.4% (n=76). The RENAL score, neutrophil-to-lymphocyte ratio (NLR), prognosis nutrition index (PNI) and Cystatin C (Cys C) were correlated to pT3a upgrading. Our model exhibited good discrimination (AUC=0.726, 95%CI:0.662-0.791) and decent calibration. In the internal validation, the high C-index value of 0.717 was still attainable. 【Conclusions】 RENAL score, NLR, PNI, and Cys C can be used to predict the risk of postoperative pT3a stage escalation in patients with cT1 stage renal cancer. Urologists can complete risk stratification and treatment based on these indicators.

Effectiveness of craniocervical flexion training combined with cervical traction among patients with cervical spondylotic radiculopathy / 预防医学

Objective@# To evaluate the effectiveness of craniocervical flexion training using pressure biofeedback combined with cervical traction among patients with cervical spondylotic radiculopathy (CSR).@*Methods@#Sixty patients with CSR receiving treatment in Center of Rehabilitation, Zhejiang Hospital from January 2020 to December 2021 were enrolled and randomly assigned into the control and treatment groups, of 30 patients in each group. All patients were given cervical traction, and patients in the treatment group were given additional craniocervical flexion training using pressure biofeedback for successive four weeks. The effectiveness of craniocervical flexion training combined with cervical traction was evaluated using Visual Analogue Scale (VAS), Neck Disability Index (NDI) and the active range of motion (AROM) of cervical flexion, and the neck pain and cervical functions were compared between the two groups before and after treatments using repeated-measures analysis of variance.@* Results@# Fifteen men were included in the treatment group, with a mean age of (49.47±5.33) years, mean disease course of (5.53±2.89) months, and mean VAS score of (4.73±1.39) points, and there were no significant differences between the control and treatment groups in terms of gender, age, course of disease or VAS score (P>0.05). The VAS score and NDI were lower 4 weeks post-treatment than pretreatment in both the treatment [VAS score: (2.13±1.01) vs. (4.73±1.39); NDI: (12.17±2.12) vs. (20.20±3.78)] and control groups [VAS score: (2.93±1.11) vs. (4.90±1.21); NDI: (15.23±2.39) vs. (19.60±3.30)], and the AROM of cervical flexion was significantly higher 4 weeks post-treatment than pretreatment in both the treatment [(42.87°±2.99°) vs. (37.50°±2.80°)] and control groups [(41.80°±3.61°) vs. (38.07°±2.99°)]; there was an interaction between time and group, and a higher improvement for cervical functions was seen in the treatment group than in the control group (FVAS =5.119, P=0.027; FNDI=15.473, P<0.001; FAROM=11.443, P<0.001). @*Conclusion@#Craniocervical flexion training using pressure biofeedback combined with cervical traction may effectively alleviate the neck pain and increase the AROM among patients with CRS, which is more effective to improve patients' cervical functions than cervical traction alone.

The diagnosis and nutritional management of chronic intestinal failure / 中华临床营养杂志

Chronic intestinal failure represents a long-lasting condition of intestinal dysfunction that contributes to inadequate absorption of macronutrients and/or water and electrolytes. It is heterogeneous in clinical manifestation, intervention and prognosis, and usually requires multi-disciplinary management. This review elucidates the state-of-the-art consensus on diagnosis and definition in chronic intestinal failure and exemplifies relevant nutritional management principles with interventions in short bowel syndrome, in hopes of improving the identification and management of chronic intestinal failure in domestic practice.

Herb-drug interaction in the protective effect of Alpinia officinarum against gastric injury induced by indomethacin based on pharmacokinetic,tissue distribution and excretion studies in rats / 药物分析学报

Alpinia officinarum Hance of the Chinese traditional herb for the treatment of emesis,abdominal pain and diarrhea has been used to counteract gastric disease induced by indomethacin in rats without obvious side effects.However,the role of herb-drug interaction between indomethacin and A.officinarum based on pharmacokinetic,tissue distribution and excretion still remains unknown.In this study,an ultra-fast liquid-tandem mass spectrometry(UFLC-MS/MS)method was developed for simultaneous determina-tion of indomethacin and its three metabolites,O-desmethylindomethacin(ODI),deschlor-obenzoylindomethacin(NDI)and indomethacin acyl-β-D-glucuronide(IDAβG)by oral administration of indomethacin solution with and without the ethanolic extract of A.officinarum and applied to comparative pharmacokinetic,tissue distribution and excretion studies.Our results clarified that oral administration of A.officinarum produced significant alterations in the pharmacokinetic parameters of indomethacin.And the pharmacokinetic interaction between indomethacin and A.officinarum reduced the systemic exposure of indomethacin and increased its elimination.Tissue distribution results demonstrated that co-administration of A.Officinarum could not reduce the accumulation of indo-methacin in the target tissue of the stomach,but could accelerate the excretions of indomethacin and its three metabolites including ODI,NDI and IDAβG in the bile and feces of rats in the excretion study.Therefore,A.Officinarum might have a gastrointestinal protective effect through the interaction role with indomethacin based on the pharmacokinetics and excretion in rats.

Study on the Mechanism of Astragali Radix in the Treatment of Ulcerative Colitis Based on Network Pharma- cology and Molecular Docking / 中国药房

OBJECTIVE：To predict the potenti al target and mechanism of Astragali Radix in the treatment of ulcerative colitis （UC），and to provide reference for the clinical application of Astragali Radix in the treatment of UC. METHODS ：The active components and their corresponding target genes of Astragali Radix were retrieved by TCMSP and UniProt KB database.related target genes of UC were searched by Gene Cards GZK-2018-5） database. The intersection target genes of Astragali Radix and were obtained by Venny 2.1.0 online mapping tool ，and interaction network of “drug-compound-intersection target ” was constructed by using Cytoscape 3.7.0 software. PPI network of intersecting targets was obtained by using STRING 结合动物模型。E-mail：172924249@qq.com database， and the visualization analysis and topological analysis w ere carried out by using Cytoscape 3.7.0 software to obtain the core target genes. By using DAVID database ，the gene ontology （GO） function annotation and KEGG pathway enrichment of intersecting target genes were carried out ，and the “target-pathway”enrichment network was constructed by using Cytoscape 3.7.0 software. Through Auto Dock vina 1.1.2 software， the top five active components in the list of degree value were linked with the protein encoded by the core target genes ；Discovery Studio 3.5 software was applied to draw out binding pattern map. RESULTS ：There were 143 compounds in Astragali Radix ，20 active components were screened out ，and 189 corresponding target genes were selected ；there were 4 356 UC disease related target genes. There were 126 intersection target genes of Astragali Radix （involving 14 active components ）and UC. The core target genes in PPI network were AKT1，MAPK1，RB1，JUN，etc. A total of 2 294 GO items （q value＜0.05）were obtained from GO functional annotation ，including 2 093 biological process items （e.g. response to lipopolysaccharide ，response to molecule of bacterial origin ），49 cell composition items （e.g. membrane raft ，membrane microdomain ），and 152 molecular function items （e.g. nuclear receptor activity ，ligand-activated transcription factor activity ）. KEGG pathway enrichment analysis yielded 160 items（q value＜0.05），such as fluid shear stress and atherosclerosis signaling pathway ，phosphatidylinositol 3 kinase/protein kinase B （PI3K/Akt） signaling pathway ，interleukin-17 （IL-17） signaling pathway. Molecular docking results showed that top 5 active ingredients （quercetin，kaempferol，formenonetin，isorhamnetin，7-O-methylisomucronulatol） in the list of degree value had binding energies ＜5.0 kcal/mol with the protein encoded core targets. CONCLUSIONS ：Quercetin，kaempferol，formononetin and other active components in Astragali Radix may play a role in the treatment of UC through the action of MAPK14，JUN，AKT1 and other target genes ，and then on the signal pathways such as PI 3K/Akt and IL- 17.

Determination of Aloesin in Rat Plasma by LC-MS/MS and Its Pharmacokinetic Study / 中国药房

OBJECTIVE：To establish a method for the determination of aloesin in plasma of rats ，and to investigate pharmacokinetic characteristics of aloesin. METHODS ：The plasma samples were precipitated with methanol. Using aloeresin D as internal standard ，the plasma concentration of aloesin was determined by LC-MS/MS. The determination was performed on Synergi Hydro-RP column with mobile phase consisted of 0.1‰ formic acid-methanol （gradient elution ）at the flow rate of 0.50 mL/min. The column temperature was 30 ℃，and sample size was 5 µL. The electrospray ionization source was applied to carry out negative ion detection with multiple reaction monitoring mode . The ion transitions for quantitative analysis were m/z 393.1→272.9（aloesin） and m/z 555.3→144.9（internal standard ），respectively. The concentration of aloesin in venous blood was determined by above method at 0.083，0.167，0.333，0.667，1，1.5，2.5，4，6，8，10 h after intravenous injection （3.35 mg/kg）and intragastric administration（16.75 mg/kg）of aloesin. DAS 3.0 software was used to calculate pharmacokinetic parameters. RESULTS ：The linear range of aloesin were 1-600 ng/mL（r＝0.994 5）. The lower limit of quantification was 1 ng/mL，and RSDs of within and between batches were less than 15％；accuracies within and between batches were within ±15％. The matrix factors were （92.74± 4.33）％-（94.84±2.57）％，and extraction recoveries were （69.04±2.13）％-（75.03±2.84）％；the deviation between the measured results of the stability test and the theoretical values were within ±15％. After intravenous injection and intragastric administration of aloesin ，main pharmacokinetic parameters were as follows ：cmax were（10 693.3±2 745.3）and（223.3±36.2）ng/mL；t1/2 were （2.45±1.45）and（3.33±1.91）h；AUC0－24h were（4 190.6±883.6）and（1 210.1±93.9）ng·h/mL（n＝3）. Absolute bioavailabi- lity was 11.13％. CONCLUSIONS ：The established method is rapid and sensitive for plasma determination of aloesin ，and suitable for its pharmacokinetic study.

An instrument for evaluating the clinical applicability of guidelines.

OBJECTIVE: To establish an instrument for evaluating the clinical applicability of guidelines from the guideline-users' perspective. METHODS: We established this instrument through forming a working group, forming an initial list of items based on a qualitative systematic review, establishing initial instrument via two rounds of modified Delphi surveys, and external review the initial instrument. RESULTS: The results of modified Delphi surveys establishing appraisal aspects, appraisal items, general information of the evaluator met the preset requirements. The instrument includes three parts: general information of the evaluator (12 items), evaluation of clinical applicability (12 items, including items on the availability, readability, acceptability, feasibility, and overall applicability of guideline), and scoring scheme. CONCLUSIONS: The instrument for evaluating the clinical applicability of guidelines from the guideline-users' perspective provides criteria and methods for improving the clinical applicability of guidelines during development and updating.

The 479th case: cognitive impairment, respiratory failure, colon mass / 中华内科杂志

A 78-year-old man was admitted to Peking Union Medical College Hospital with fever, weakness of lower extremities, less speech, loss of memory. Fever was relieved after antibiotic treatment, while cognitive impairment and disorder of consciousness progressed rapidly, followed by critical pulmonary infections, respiratory failure, and septic shock. Lab tests showed negative occult blood, normal serum CEA level and positive Anti-nuclear-antibody. PET-CT suggested that strong FDG uptake signals were seen at sigmoid, while bilateral frontal lobe, temporal lobe, parietal lobe, posterior cingulate gyrus showed lower metabolic activity. Colonoscopy biopsy revealed differentiated adenocarcinoma of sigmoid colon. Therefore, paraneoplastic syndrome of nervous system secondary to colon cancer was considered. Rapid and proper diagnosis and treatment were completed by multidisciplinary team including departments of neurology, gastroenterology, general surgery, ICU, rheumatology, clinical nutrition. The laparoscopic sigmoid colectomy was performed under general anesthesia. The patient finally presented with significant improvement of cognition and consciousness. Respiratory function was totally recovered.

Accuracy and clinical application of a REF-XT01 uric acid meter / 中华内分泌代谢杂志

Objective:This study aimed to evaluate the accuracy of a portable REF-XT01 uric acid meter in measuring blood uric acid concentration, and to determine whether the results of the uric acid meter could be used to guide the adjustment of uric acid-lowering drugs.Methods:1 551 subjects were enrolled from the Gout Clinical Medical Center of the Affiliated Hospital of Qingdao University. The fasting venous blood was collected and the serum uric acid was measured by an automatic biochemical analyzer. Meanwhile, the capillary blood uric acid was measured by fingertip puncture using the REF-XT01 uric acid meter. Linear regression, intra-group correlation coefficient(ICC), and Bland-Altman plots were used to analyze the uric acid concentration correlation between the biochemical analyzer(sUA BA)and the uric acid meter(sUA UM). The receiver operating characteristic curve(ROC curve)was conducted to evaluate whether sUA UM can be used as a reference for the gout patients to take uric acid-lowering drugs. Results:The regression analysis showed correlation between sUA BA and sUA UM, with the regression formula Y=0.875X+ 39.525( r=0.84, P<0.01)and the ICC was 0.829(95% CI 0.814-0.844, P<0.01). The Bland-Altman diagram showed a good consistence(the absolute deviation was-143.4-114.5 μmol/L, mean deviation was -14.4 μmol/L)between sUA BA and sUA UM. The sensitivity was 96.61%, specificity was 48.81%, and the area under the ROC curve(AUC)was 0.926( P<0.01)when 300 μmol/L was defined as the detection threshold of the uric acid meter, the sensitivity was 90.98%, specificity was 66.78%, and the area under the ROC curve(AUC)was 0.914( P<0.01)when 360 μmol/L was defined as the detection threshold of the uric acid meter. Conclusion:REF-XT01 uric acid meter is applicable for the adjustment of uric acid-lowering drugs for the gout patients, because of its high accuracy for the detection of uric acid.

Spatial distribution and molecular identification of small mammals in the areas of natural focus disease in Qinghai Province / 中华地方病学杂志

Objective:To understand the spatial distribution of small mammals in the areas of natural focus disease in Qinghai Province, and to identify captured small mammals at the molecular level using mitochondrial cytochrome C oxidase subunit I (COI) gene as molecular marker.Methods:In 2009 - 2016, the distribution of regional spatial, elevation distribution and ecological environment type of captured small mammals were analyzed in 16 cities (counties) of 6 prefectures in Qinghai Province. The partial COI gene fragment sequence (about 650 bp in length) was obtained by PCR amplification, which was further analyzed through homology comparison, genetic distance and phylogenetic analysis.Results:Totally 1 631 small mammals were captured that had belonged to 30 species of 21 genera, 7 families, 3 orders. Among them there were 926 rodent animals that had belonged to 25 species of 19 genera, 5 families, accounting for 56.78%. There was the largest number in Golmud (313 animals), the highest distribution of small mammals was found at the elevation of 2 800 - < 3 000 m (532 animals), the largest number of small mammals was found in the sandy grassland (612 animals). COI genes of 292 small mammals were successfully amplified, and the homology was consistent with the target sequence. The results showed that the intraspecific genetic distance ranged from 0.01% to 2.90%, interspecific genetic distance ranged from 4.00% to 12.00%, intergenus genetic distance was 13.00% - 21.00% and interfamily genetic distance was 22.00% - 25.00%. The interspecific genetic distance was significantly greater than the intraspecific genetic distance. Neighbor-Joining tree showed that the same species were clustered into a single branch with high support form a total of 20, with a confidence level of 98% to 100%.Conclusions:The spatial distribution of small mammals is influenced by geographical factors such as region, elevation and ecological environment in Qinghai Province. Molecular identification can make up for the shortcomings in morphological identification.

Comparison of curative effect of different surgical methods on varicocele / 国际外科学杂志

Objective To compare the curative effect of three different surgical methods:peritoneal varicocele ligation,peritoneal single-port laparoscopy and microscopy on varicocele.Methods Retrospective analysis of the case data of 150 patients with varicocele treated in the Affiliated Hospital of Xuzhou Medical University from September 2016 to September 2018.The average age was 24.5 years,and the age range was 22-30 years.The patients were divided into three groups according to different surgical methods:open group,laparoscopy group and microscope group,with 50 cases in each group.Patients in the open group were treated with retroperitoneal spermatic cord ligation.Patients in the laparoscopic group were treated with single-hole laparoscopic laparoscopic surgery.Patients in the microscope group were treated with microscope surgery.Operation time,postoperative hospitalization time,hospitalization cost reserved arteries,surgical complications (such as testicular hydrocele,scrotal edema,epididymitis,testicular atrophy),recurrence,and semen quality improvement were compared between three groups.Measurement data were expressed as mean ± standard deviation(Mean ± SD),the two comparisons used the t test,the comparison between the three groups used the analysis of variance,and the comparison between the count data groups using the Chi-square test.Results The operation time of the patients in the microscope group [(52.52 ± 4.29) min] was longer than that of the open group [(36.60 ± 3.69) min] and the laparoscopic group [(39.54 ± 2.87) min].The difference between the two groups was statistically significant (P ＜ 0.05);but the postoperative hospitalization time and hospitalization cost of patients in the microscope group [(2.16±0.95) d,(5251 ± 300) yuan] were higher than those in the open group [(3.80±0.78) d,(64 75 ±415) yuan)] and the laparoscopic group [(3.28 ± 1.01) d,(7 379 ± 273) yuan].The results of pairwise comparison showed that the difference between the microscope group,the open group and the laparoscopic group was statistically significant (P ＜0.05).Arterial preservation in the microscope group [47(94.0％)] were compared with the open group [35 (70.0％)],and laparoscopic group [30(60.0％)] had obvious advantages.Pairwise comparison results showed that the comparison between the microscope group and the open group and the laparoscopic group was statistically significant (P ＜ 0.05).After follow-up for six months,2 cases were lost to follow-up in the microscope group,1 cases were lost to the open group,and 5 case was lost to the unilateral laparoscopic group.2(4.2％) patients had complications in the microscope group,and 14 (28.6％) patients had complications in the open group;9 (20.0％) patients had complications in the laparoscopic group,and the total incidence of complications showed a pairwise comparison,the difference between the microscope group,the open group and the laparoscopic group was significant (P ＜ 0.05).The recurrence rate in the microscope group was 2.1％ (1/48),the recurrence rate in the open group was 18.4％ (9/49),and the recurrence rate in the laparoscopic group was 13.3％ (6/45);the recurrence rate was compared in pairs,the difference between the microscope group,the open group and the laparoscopic group was significant (P ＜ 0.05).The improvement rate of semen quality in the microscope group was 68.8％ (33/48),the open group was 42.9％ (21/49),the laparoscopic group was 55.6％ (25/45),pairwise comparison results showed that the microscope group compared with the open group and laparoscopy group,the difference were statistically significant (P ＜ 0.05).Conclusions Microscopic surgery has less trauma,faster postoperative recovery,shorter operation cost and hospitalization time.Postoperative complications and recurrence,and improved semen quality are all superior to open spermatic vein ligation and single-hole umbilical laparoscopic surgery,it is a safe and effective way to treat varicocele.

Comparison of curative effect of different surgical methods on varicocele / 国际外科学杂志

Objective@#To compare the curative effect of three different surgical methods: peritoneal varicocele ligation, peritoneal single-port laparoscopy and microscopy on varicocele.@*Methods@#Retrospective analysis of the case data of 150 patients with varicocele treated in the Affiliated Hospital of Xuzhou Medical University from September 2016 to September 2018. The average age was 24.5 years, and the age range was 22-30 years. The patients were divided into three groups according to different surgical methods: open group, laparoscopy group and microscope group, with 50 cases in each group. Patients in the open group were treated with retroperitoneal spermatic cord ligation. Patients in the laparoscopic group were treated with single-hole laparoscopic laparoscopic surgery. Patients in the microscope group were treated with microscope surgery. Operation time, postoperative hospitalization time, hospitalization cost reserved arteries, surgical complications (such as testicular hydrocele, scrotal edema, epididymitis, testicular atrophy), recurrence, and semen quality improvement were compared between three groups. Measurement data were expressed as mean ± standard deviation(Mean±SD), the two comparisons used the t test, the comparison between the three groups used the analysis of variance, and the comparison between the count data groups using the Chi-square test.@*Results@#The operation time of the patients in the microscope group [(52.52 ± 4.29) min] was longer than that of the open group [(36.60±3.69) min] and the laparoscopic group [(39.54±2.87) min]. The difference between the two groups was statistically significant (P<0.05); but the postoperative hospitalization time and hospitalization cost of patients in the microscope group [(2.16±0.95) d, (5 251 ± 300) yuan] were higher than those in the open group [(3.80±0.78) d, (64 75±415) yuan)]and the laparoscopic group [(3.28±1.01)d, (7 379±273) yuan] . The results of pairwise comparison showed that the difference between the microscope group, the open group and the laparoscopic group was statistically significant (P<0.05). Arterial preservation in the microscope group [47(94.0%)] were compared with the open group [35 (70.0%)], and laparoscopic group [30(60.0%)] had obvious advantages. Pairwise comparison results showed that the comparison between the microscope group and the open group and the laparoscopic group was statistically significant (P<0.05). After follow-up for six months, 2 cases were lost to follow-up in the microscope group, 1 cases were lost to the open group, and 5 case was lost to the unilateral laparoscopic group. 2(4.2%) patients had complications in the microscope group, and 14 (28.6%) patients had complications in the open group; 9 (20.0%) patients had complications in the laparoscopic group, and the total incidence of complications showed a pairwise comparison, the difference between the microscope group, the open group and the laparoscopic group was significant (P<0.05). The recurrence rate in the microscope group was 2.1% (1/48), the recurrence rate in the open group was 18.4% (9/49), and the recurrence rate in the laparoscopic group was 13.3% (6/45); the recurrence rate was compared in pairs, the difference between the microscope group, the open group and the laparoscopic group was significant (P<0.05) . The improvement rate of semen quality in the microscope group was 68.8% (33/48), the open group was 42.9%(21/49), the laparoscopic group was 55.6%(25/45), pairwise comparison results showed that the microscope group compared with the open group and laparoscopy group, the difference were statistically significant (P<0.05).@*Conclusions@#Microscopic surgery has less trauma, faster postoperative recovery, shorter operation cost and hospitalization time. Postoperative complications and recurrence, and improved semen quality are all superior to open spermatic vein ligation and single-hole umbilical laparoscopic surgery, it is a safe and effective way to treat varicocele.

Influencing factors for anxiety and depression in patients with dysphagia after stroke / 预防医学

Objective @#To investigate the influencing factors for depression and anxiety in patients with dysphagia after stroke.@*Methods@# From May 2017 to June 2018,patients with post-stroke dysphagia in the Department of Rehabilitation Medicine of Zhejiang Hospital were recruited to collect their height,weight,education level,serum nutritional indicators and feeding patterns. Self-Rating Anxiety Scale and Self-Rating Depression Scale were employed to assess the incidence of anxiety and depression. Multivariate logistic regression model was used to analyze the influencing factors for depression and anxiety. @*Results @#Among 96 patients enrolled,43 suffered from anxiety and depression,with the incidence of 44.79%. The results of multivariate logistic regression analysis showed that normal albumin（OR=0.208,95%CI：0.054-0.800）was a protective factor for anxiety,while indwelling gastric tube（OR=5.789,95%CI：1.654-20.260）was a risk factor. Normal transferrin（OR=0.189,95%CI：0.042-0.860）was a protective factor for depression,while indwelling gastric tube（OR=13.977,95%CI：1.472-132.667）was a risk factor. @*Conclusion @#Normal albumin and transferrin are the protective factors for anxiety and depression in patients with dysphagia after stroke,and indwelling gastric tube is the risk factor for anxiety or depression.

Comparative Study on Ideal and Realistic Doctor-patient Relationship / 中国医学伦理学

"Good doctor" plus "good patient" do not necessarily mean "good doctor-patient relationship", but both are the basis for building a harmonious doctor -patient relationship and neither of the two can be dis-pensed. This paper conducted a comparative study on ideal and realistic doctor-patient relationship, digged and refined the characteristics of"good doctor" and"good patients", and agreed that it was possible to construct a har-monious doctor-patient relationship when doctors pursued professional excellence and moral integrity, and patients had good "patient literacy".

Molecular identification of main vector fleas in Qinghai plague foci by DNA barcoding / 中华地方病学杂志

Objective To make up the limitations of traditional morphological classification methods,we identified vector fleas by DNA barcoding in Qinghai Province.Methods The mt DNA cytochrome c oxidase subunit Ⅰ (CO Ⅰ) gene was amplified by PCR from 36 muscle tissues of fleas in 3 states,2 cities and 5 counties of Qinghai Province,and the obtained CO Ⅰ gene fragments were sequenced and aligned.The intra-and inter-species genetic distances were calculated with Mega 6 software using K2-P model and a phylogenetic tree was constructed with neighbor-joining (NJ) method.Results Totally 36 CO Ⅰ gene sequences of 2 superfamilies,4 genera and 6 kinds of vector fleas were measured,the average genetic distance was 0.119,and the intraspecific distance was 0.002-0.027,the interspecific distance was 0.039-0.207,and the interspecific genetic distance was significantly greater than the intraspecific genetic distance.NJ tree showed the same species had formed a single line with high support rate and interspecific branch was clear.Conclusion DNA barcoding is suitable for identification of vector fleas in Qinghai Province,may make up the limitations of traditional morphological classification methods.

A multi-parameter resting-state functional magnetic resonance imaging study of brain intrinsic activity in attention deficit hyperactivity disorder children / 生物医学工程学杂志

A great number of studies have demonstrated functional abnormalities in children with attention-deficit/hyperactivity disorder (ADHD), although conflicting results have also been reported. And few studies analyzed homotopic functional connectivity between hemispheres. In this study, resting-state functional magnetic resonance imaging (MRI) data were recorded from 45 medication-naïve ADHD children and 26 healthy controls. The regional homogeneity (ReHo), degree centrality (DC) and voxel-mirrored homotopic connectivity (VMHC) values were compared between the two groups to depict the intrinsic brain activities. We found that ADHD children exhibited significantly lower ReHo and DC values in the right middle frontal gyrus and the two values correlated with each other; moreover, lower VMHC values were found in the bilateral occipital lobes of ADHD children, which was negatively related with anxiety scores of Conners' Parent Rating Scale (CPRS-R) and positively related with completed categories of Wisconsin Card Sorting Test (WCST). Our results might suggest that less spontaneous neuronal activities of the right middle frontal gyrus and the bilateral occipital lobes in ADHD children.