A nonlinear relationship between the hemoglobin level and prognosis of elderly patients with sepsis: an analysis based on MIMIC-IV / 中华危重病急救医学

OBJECTIVE@#To investigate the correlation of hemoglobin (Hb) level with prognosis of elderly patients diagnosed as sepsis.@*METHODS@#A retrospective cohort study was conducted. Information on the cases of elderly patients with sepsis in the Medical Information Mart for Intensive Care-IV (MIMIC-IV), including basic information, blood pressure, routine blood test results [the Hb level of a patient was defined as his/her maximum Hb level from 6 hours before admission to intensive care unit (ICU) and 24 hours after admission to ICU], blood biochemical indexes, coagulation function, vital signs, severity score and outcome indicators were extracted. The curves of Hb level vs. 28-day mortality risk were developed by using the restricted cubic spline model based on the Cox regression analysis. The patients were divided into four groups (Hb < 100 g/L, 100 g/L ≤ Hb < 130 g/L, 130 g/L ≤ Hb < 150 g/L, Hb ≥ 150 g/L groups) based on these curves. The outcome indicators of patients in each group were analyzed, and the 28-day Kaplan-Meier survival curve was drawn. Logistic regression model and Cox regression model were used to analyze the relationship between Hb level and 28-day mortality risk in different groups.@*RESULTS@#A total of 7 473 elderly patients with sepsis were included. There was a "U" curve relationship between Hb levels within 24 hours after ICU admission and the risk of 28-day mortality in patients with sepsis. The patients with 100 g/L ≤ Hb < 130 g/L had a lower risk of 28-day mortality. When Hb level was less than 100 g/L, the risk of death decreased gradually with the increase of Hb level. When Hb level was ≥ 130 g/L, the risk of death gradually increased with the increase of Hb level. Multivariate Logistic regression analysis revealed that the mortality risks of patients with Hb < 100 g/L [odds ratio (OR) = 1.44, 95% confidence interval (95%CI) was 1.23-1.70, P < 0.001] and Hb ≥ 150 g/L (OR = 1.77, 95%CI was 1.26-2.49, P = 0.001) increased significantly in the model involving all confounding factors; the mortality risks of patients with 130 g/L ≤ Hb < 150 g/L increased, while the difference was not statistically significant (OR = 1.21, 95%CI was 0.99-1.48, P = 0.057). The multivariate Cox regression analysis suggested that the mortality risks of patients with Hb < 100 g/L [hazard ratio (HR) = 1.27, 95%CI was 1.12-1.44, P < 0.001] and Hb ≥ 150 g/L (HR = 1.49, 95%CI was 1.16-1.93, P = 0.002) increased significantly in the model involving all confounding factors; the mortality risks of patients with 130 g/L ≤ Hb < 150 g/L increased, while the difference was not statistically significant (HR = 1.17, 95%CI was 0.99-1.37, P = 0.053). Kaplan-Meier survival curve showed that the 28-day survival rate of elderly septic patients in 100 g/L ≤ Hb < 130 g/L group was significantly higher than that in Hb < 100 g/L, 130 g/L ≤ Hb < 150 g/L and Hb ≥ 150 g/L groups (85.26% vs. 77.33%, 79.81%, 74.33%; Log-Rank test: χ2 = 71.850, P < 0.001).@*CONCLUSIONS@#Elderly patients with sepsis exhibited low mortality risk if their 100 g/L ≤ Hb < 130 g/L within 24 hours after admission to ICU, and both higher and lower Hb levels led to increased mortality risks.

A case of developmental epileptic encephalopathy type 67 caused by CUX2 gene mutation and literature review / 中华神经科杂志

Objective:To summarize the clinical phenotype and CUX2 gene variation characteristics of developmental epileptic encephalopathy type 67 confirmed by whole exome sequencing. Methods:Clinical data of 1 case diagnosed as CUX2 gene mutations related developmental epileptic encephalopathy type 67 in the Children′s Hospital Affiliated to Zhengzhou University in January 2021 were collected, the patient′s clinical characteristics, genetic testing, head imaging, electroencephalogram results and treatment were summarized, and the patient was regularly followed-up every 3 months. At the same time, the domestic and foreign literatures on epileptic encephalopathy caused by CUX2 gene mutation were reviewed. Results:The proband was a 6 years and 4 months old girl. The main clinical manifestations included focal origin progression to bilateral tonic-clonic seizures, retardation of intellectual, language, and motor development, autistic behavior, hyperactivity disorder, and involuntary hand clapping. The video electroencephalogram showed extensive spiny slow wave and multi-spiny slow wave emission in waking and sleeping stages, and spiny slow wave and spiky slow wave emission in bilateral anterior head in sleeping stage. Brain magnetic resonance imaging (MRI) plain scan and T 2-fluid attenuated inversion recovery (T 2-FLAIR) thin layer scan showed that the signal of the left hippocampus was higher than that of the right, and the left hippocampus was slightly swollen. One month later, the brain MRI and T 2-FLAIR were reexamined. The left hippocampal signal was still slightly higher and decreased, and the hippocampal volume was slightly reduced. Whole exome sequencing showed the CUX2 gene with c.1768G>A(p.Glu590Lys) heterozygous missense variant, which was a reported de novo pathogenic variant and both of her parents were wild-type. A total of 10 cases of new heterozygous missense variants in CUX2 gene [c.1768G>A (p.Gelu590Lys)] were reported in 4 literatures. No relevant cases have been reported in China. Conclusions:Developmental epileptic encephalopathy type 67 is relatively rare. The main clinical features are seizures, global developmental delay, movement disorders, athetosis, autism and hyperactivity disorder. The heterozygous missense variant c.1768G>A (Glu590Lys) of CUX2 gene maybe the genetic cause of this case.

Sensitization characteristics of ragweed pollen in Beijing area / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the sensitization characteristics of ragweed pollen in patients with allergic rhinitis（AR） and（or） allergic asthma in Beijing area, and to provide basis for the prevention and treatment of ragweed pollen sensitized population. Methods:Patients with allergic rhinitis and/or asthma from January 2017 to December 2019 in the outpatient department of Allergy Department of Beijing Shijitan Hospital were retrospectively analyzed in this study. Skin prick test（SPT） was performed with ragweed pollen allergen reagents to compare different ages, genders and respiratory diseases allergen distribution, and to observe the sensitization characteristics of its population. All of the analyses were performed using SAS software version 9.4. Results:A total of 9 727 patients were enrolled in the end. The total positive rate of ragweed pollen SPT was 45.50%（4 426/9 727）, the highest positive rate was 65.54% in 13-17 years old group; The positive rate of ragweed pollen SPT was 49.79% in allergic rhinitis combined with asthma patients, followed by 46.46% in allergic rhinitis patients, and the lowest rate was 19.42% in single allergic asthma patients. There were more females than males in both ragweed pollen sensitized and non-ragweed pollen sensitized groups（P<0.05）, and the proportion was higher in 30-39 years old than in other age groups（P<0.05）. Ragweed pollen sensitization was higher than non-ragweed pollen sensitization in the allergic rhinitis group（98.49% vs 94.76%, P<0.05）. Ragweed pollen with other summer and autumn pollen allergens in patients with positive SPT, the top three were Chenopodium pollen, Humulus pollen and Artemisia grandis pollen, with positive rates of 90.42%, 89.63% and 85.40%, respectively. Ragweed combined with other pollen sensitization accounted for 99.57%（4 407/4 426）. Allergic rhinitis was the main disease in patients sensitized with ragweed pollen alone or combined with other pollens, and there was no significant difference between the two groups（94.97% vs 98.50%, P>0.05）. Conclusion:Ragweed pollen is highly sensitized in Beijing area, single ragweed pollen sensitization is rare, often combined with multiple pollen sensitization, and allergic rhinitis is the main disease.

Progress on allergen immunotherapy during pre-pregnancy, pregnancy, and lactation periods / 中华围产医学杂志

Allergen immunotherapy (AIT), also known as allergen vaccine desensitization, is currently the only treatment that can change the natural course of allergic diseases. AIT for pregnant women is a protective factor for neonatal allergies. Existing findings suggest that AIT should not be started during pre-pregnancy, pregnancy, or lactation periods, but can be continued if has already been started before; unexpected pregnancy during AIT does not require termination; AIT shows no obvious adverse effects on fetuses, infants, and young children. The latest evidence on the effectiveness and safety of AIT during pre-pregnancy, pregnancy, and lactation periods were reviewed.

Clinical phenotype and gene analysis of TSC2/PKD1 adjacency gene syndrome / 中华神经科杂志

Objective:To explore the clinical phenotype and gene characteristics of a case of TSC2/PKD1 adjacency gene syndrome, so as to improve the clinical understanding of the disease.Methods:A case of TSC2/PKD1 adjacency gene syndrome diagnosed in the Department of Neurology of the Children′s Hospital Affiliated to Zhengzhou University was analyzed retrospectively. The clinical data, laboratory examination, imaging characteristics and gene variation characteristics of the child were summarized.Results:The patient was a 17 months old girl, with the main complaint of "intermittent convulsion with 17 months of underdevelopment". The clinical manifestations were epileptic seizures, which were in the form of a series of spastic seizures, absence seizures, focal seizures, and depigmentation spots can be seen in the trunk and neck. Cranial magnetic resonance imaging showed multiple patchy signals in the cortex and subcortical areas of the bilateral cerebral hemispheres, multiple small nodular shadows under the ependyma of the bilateral lateral ventricles, the heart color Doppler ultrasound showed patent foramen ovale and pericardial effusion, and the abdomen color Doppler ultrasound showed polycystic kidney. Ophthalmic color Doppler ultrasound showed that there were localized small swelling lesions around the optic disc of the left eye. The whole exon gene sequencing of the pedigree showed the proband had partial deletion of TSC2 gene (NM_000548) at chromosome position chr16: 2125799-2185690. The real-time quantitative detection system verified that exons 23-42 were deleted, and all exons of PKD1 gene were deleted (NM_001009944), and multiple ligation dependent probe amplification verified that exons 1-46 were deleted, and no downstream gene deletion was found. The overall deletion size was about 60 kb. Both of the girl's father and mother had normal phenotypes and were wild-type.Conclusions:TSC2/PKD1 adjacency gene syndrome is relatively rare. It can have clinical manifestations of tuberous sclerosis/autosomal dominant polycystic kidney disease. Most of the nervous system and kidney are seriously affected, and the prognosis is poor. TSC2/PKD1 gene deletion and variation is the genetic cause of the TSC2/PKD1 adjacency gene syndrome.

Clinical characteristics and literature review of a case of Christianson syndrome caused by SLC9A6 gene variation / 中华神经科杂志

Objective:To retrospectively analyze the clinical data of Christianson syndrome caused by SLC9A6 gene mutation and related literatures.Methods:The clinical data of one Christianson syndrome patient caused by SLC9A6 gene variation in Children′s Hospital of Zhengzhou University were collected, meanwhile the relevant literature was reviewed. The examination of video electroencephalogram, auditory brainstem response, and cranial magnetic resonance imaging (MRI) was performed. Whole exon sequencing and mitochondrial gene detection were performed for 3 persons in the family, and the suspected mutation sites were verified by Sanger sequencing.Results:A boy, 7 years old, presented with epilepsy, language retardation and mental retardation. Now he can only say overlapping words, execute simple instructions, denying family history of genetic disease and genetic metabolic disease. The patient′s uncle had the history of febrile convulsions in childhood. At present, speech and intelligence are impaired, and the left limb movement is slightly limited. The patient′s mother was mildly retarded, without epilepsy. The video- electroencephalogram of the patient was shown below (April 2021): abnormal electroencephalogram; background activity was slightly slow; the bilateral frontotemporal region was dominated by multi-focal spiky wave, spiky slow wave and slow wave in each waking and sleeping stage, which can be generalized and extensive; in the sleeping stage, the discharge index in non-rapid eye movement stage was about 75%. The auditory brainstem response was shown below (October 2021): the left 70 dB Ⅰwave latency was prolonged; the Ⅰwave Ⅴ wave shape was poor; the threshold was 20 dB (the high frequency threshold was normal); the right 70 dB Ⅰwave latency was prolonged; the wave form was poor; the amplitude was lower than that of the contralateral side; Ⅲ wave Ⅴ wave shape was poor; the threshold was 30 dB (the high frequency threshold slightly increased). Brain MRI thin-section scan was shown below (January 2021): subarachnoid space of bilateral temporal poles widened, and no obvious abnormal signal was found in brain parenchyma; sinusitis. Whole exome sequencing of 3 persons in the family indicated that the proband had a hemizygous variant c.616C>T (p.R206 *) in the SLC9A6 gene. Using the SLC9A6 gene and Christianson syndrome as the key words, 94 foreign literatures from January 1989 to January 2022 were researched. Totally, 81 Christianson syndrome patients caused by SLC9A6 gene mutation were reported. The age of onset ranged from neonatal period to adulthood, and the clinical manifestations were heterogeneous. The symptoms of male patients mainly included epilepsy, severe cognitive impairment, ataxia, cerebellar atrophy, and psychomotor retardation. Conclusions:The hemizygous variant of SLC9A6 gene (c.616C>T) is the etiology of this patient. The possibility of Christianson syndrome shall be considered for recurrent epilepsy with poor efficacy of antiepileptic drugs, status epilepticus during slow-wave sleep, and delayed development of motor intelligence. Genetic testing is helpful for definite diagnosis and treatment.

Treatment outcome and influencing factors of isoniazid mono-resistant pulmonary tuberculosis / 中华传染病杂志

Objective:To analyze the outcomes of isoniazid (INH) mono-resistant pulmonary tuberculosis, and risk factors associated with adverse treatment outcomes of INH mono-resistant pulmonary tuberculosis.Methods:A total of 114 cases of INH mono-resistant pulmonary tuberculosis in Xi′an Chest Hospital from January 1, 2018 to December 31, 2020 were retrospectively recruited for analysis. The general information, clinical symptoms, and laboratory test results of patients were collected. With treatment success and adverse treatment outcomes as dependent variables, binary logistic regression analysis was used to analyze the risk factors for the adverse treatment outcome of INH mono-resistant pulmonary tuberculosis.Results:Among 114 patients with INH mono-resistant tuberculosis, 46 cases (40.4%) were cured and 41 cases (36.0%) completed treatment with the success rate of 76.3%(87/114), while 11 cases (9.6%) failed treatment, 13 cases (11.4%) lost to follow up, three cases (2.6%) died.The binary logistic regression analysis showed that male (odds ratio ( OR)=7.22, 95% confidence interval ( CI) 1.47 to 35.43)), no fever at onset ( OR=12.97, 95% CI 2.74 to 61.55), not containing amikacin in the regimen ( OR=5.28, 95% CI 1.20 to 23.31), sputum bacteria load >1+ ( OR=5.87, 95% CI 1.76 to 19.60) were the risk factors for adverse treatment outcomes of INH mono-resistant tuberculosis. Conclusions:The treatment success rate of INH mono-resistant pulmonary tuberculosis patients is high. The risk factors for adverse treatment outcome are male, no fever at the onset, not containing amikacin in the regimen, and sputum bacteria load >1+ .

Evidence-based practice competence of masters of nursing specialist and its influencing factors / 中国实用护理杂志

Objective:To explore the current situation of evidence-based practice competence of masters of nursing specialist at Class Ⅲ hospitals and its influencing factors so as to provide decision-making basis for optimizing the construction and educational management of clinical teaching base for masters of nursing specialist.Methods:From July to October 2021, 141 masters of nursing specialist of Class Ⅲ hospitals in Tianjin were selected as subjects by purposive sampling. All students were investigated with the Chinese version of Evidence Based Practice Evaluation Competence Questionnaire (EBP-COQ) and the Barriers to Research Utilization Scale. Multiple linear regression was used to analyze the influencing factors.Results:Among 141 masters of nursing specialist, the total scores of the EBP-COQ and the Barriers to Research Utilization Scale were 95.35 ± 11.90 and 72.52 ± 26.28 respectively. Multiple linear regression analysis showed that the influencing factors of evidence based practice competence of masters of nursing specialist included the results of availability and the awareness of evidence-based nursing ( r = -2.85, -2.41, both P<0.05). Conclusions:Masters of nursing specialist have the intermediate level of evidence-based practice competence and positive attitudes to evidence based practice, but their evidence-based knowledge and skills need to be improved. Clinical teaching base managers should pay attention to the training of evidence-based nursing practice ability of professional nursing master students, provide more supportive resources and environment, and promote the development of specialty nursing practice.

IRF4 and IRF8 expression are associated with clinical phenotype and clinico-hematological response to hydroxyurea in essential thrombocythemia / 医学前沿

The morbidity and mortality of myeloproliferative neoplasms (MPNs) are primarily caused by arterial and venous complications, progression to myelofibrosis, and transformation to acute leukemia. However, identifying molecular-based biomarkers for risk stratification of patients with MPNs remains a challenge. We have previously shown that interferon regulatory factor-8 (IRF8) and IRF4 serve as tumor suppressors in myeloid cells. In this study, we evaluated the expression of IRF4 and IRF8 and the JAK2V617F mutant allele burden in patients with MPNs. Patients with decreased IRF4 expression were correlated with a more developed MPN phenotype in myelofibrosis (MF) and secondary AML (sAML) transformed from MPNs versus essential thrombocythemia (ET). Negative correlations between the JAK2V617F allele burden and the expression of IRF8 (P < 0.05) and IRF4 (P < 0.001) and between white blood cell (WBC) count and IRF4 expression (P < 0.05) were found in ET patients. IRF8 expression was negatively correlated with the JAK2V617F allele burden (P < 0.05) in polycythemia vera patients. Complete response (CR), partial response (PR), and no response (NR) were observed in 67.5%,10%, and 22.5% of ET patients treated with hydroxyurea (HU), respectively, in 12 months. At 3 months, patients in the CR group showed high IRF4 and IRF8 expression compared with patients in the PR and NR groups. In the 12-month therapy period, low IRF4 and IRF8 expression were independently associated with the unfavorable response to HU and high WBC count. Our data indicate that the expression of IRF4 and IRF8 was associated with the MPN phenotype, which may serve as biomarkers for the response to HU in ET.

A SARS-CoV-2 Reference Standard Quantified by Multi-digital PCR Platforms for Quality Assessment of Molecular Tests

SARS-CoV-2 is the seventh coronavirus known to infect humans and has caused an emerging and rapidly evolving global pandemic (COVID-19) with significant morbidity and mortality. To meet the urgent and massive demand for the screening and diagnosis of infected individuals, many in vitro diagnostic assays using nucleic acid tests (NATs) have been urgently authorized by regulators worldwide. The limit of detection (LoD) is a crucial feature for a diagnostic assay to detect SARS-CoV-2 in clinical samples, and a reference standard with a well-characterized concentration or titer is of the utmost importance for LoD studies. Although several reference standards of plasmids or synthetic RNA carrying specific genomic regions of SARS-CoV-2 have already been announced, a reference standard for inactivated virus particles with accurate concentration is still needed to evaluate the complete procedure including nucleic acid extraction and to accommodate customized primer-probe sets targeting different genome sequences. Here, we performed a collaborative study to estimate the NAT-detectable units as viral genomic equivalent quantity (GEQ) of an inactivated whole-virus SARS-CoV-2 reference standard candidate using digital PCR (dPCR) on multiple commercialized platforms. The median of the quantification results (4.6x105 {+/-} 6.5x104 GEQ/mL) was treated as the consensus true value of GEQ of virus particles in the reference standard. This reference standard was then used to challenge the LoDs of six officially approved diagnostic assays. Our study demonstrates that an inactivated whole virus quantified by dPCR can serve as a reference standard and provides a unified solution for assay development, quality control, and regulatory surveillance.

Mindfulness, rumination and post-traumatic growth in a Chinese cancer sample.

A multiple mediation structural equation model was used to test the relationship between mindfulness, deliberate rumination, intrusive rumination and post-traumatic growth (PTG) among Chinese cancer patients. Data were collected from 309 cancer patients in China (61.2% male, 38.8% female), who completed questionnaires comprising the Mindful Attention Awareness Scale, the Event Related Rumination Inventory and the Post-traumatic Growth Inventory. The multiple mediation structural equation model showed that deliberate rumination partially mediated the relationship between mindfulness and PTG. However, the mediatory effect of intrusive rumination was not significant. Our findings indicated that deliberate rumination functions as an essential mechanism in the relationship between mindfulness and PTG. The results showed that interventions to increase mindfulness are needed in order to encourage PTG.

A preliminary study on the potential value of QuantiFERON-TB Gold Plus(QFT-Plus) in identification of latent tuberculosis infection and active tuberculosis / 中华检验医学杂志

Objective:To evaluate the potential differential diagnostic value of QuantiFERON-TB Gold Plus(QFT-Plus) in patients with active tuberculosis (ATB) and latent tuberculosis infection (LTBI) people.Methods:Case-control study. A total of 108 healthcare workers and 30 ATB patients in Xi′an Chest Hospital were tested by QFT-Plus from April to November 2019, and the demographic characteristics were analyzed.Then, flow cytometry was used to analyze the relations between the QFT-Plus TB2-TB1 and the distribution of peripheral blood T lymphocyte subsets in ATB patients with positive culture results.Finally, with 34 QFT-Plus positive volunteers as LTBI group and 30 bacteriologically confirmed ATB patients as ATB group, the QFT-Plus new lyadded antigen and its potential differential diagnostic value between LTBI and ATB groups was evaluated by using the receiver operating curve (ROC).Results:In patients with ATB,QFT-plus TB2-TB1 was positively correlated with the proportion of CD8+T cells in peripheral blood T lymphocytes( r=0.586, P=0.004), negatively correlated with the proportion of CD4+ T cells( r=-0.511, P=0.015) and the ratio of CD4/CD8 ( r=-0.520, P=0.013).The peripheral blood TB2-TB1 in the ATB patients was significantly higher than that in the LTBI group[0.47(0.12,1.17) IU/ml versus 0.01(-0.08,0.22) IU/ml, U=233.5, P<0.001]. QFT-Plus TB2-TB1 can effectively distinguish ATB from LTBI, with an area under the ROC curve of 0.771 (95 %CI=0.653-0.889, P<0.001). Conclusion:QFT-Plus specific CD8 response (TB2-TB1) has the potential value to identify ATB from LTBI people.

The reliability and validity of the Chinese version of Families′ Importance in Nursing Care -Nurses Attitudes / 中国实用护理杂志

Objective:To translate the English version of Families′ Importance in Nursing Care-Nurses Attitudes Scale (FINC-NA) into Chinese,and test the reliability and validity of the scale for initially establishing a Chinese version of FINC-NA.Methods:A total of 661 clinical nurses were tested from Tianjin Medical University Cancer Institute and Hospital using the Chinese version of FINC-NA which was developed through the process of translation,back-translation and cultural adaptation to verify its reliability and validity according to Brislin model.Results:The Chinese version of FINC-NA was extracted for 4 factors by the factor analysis using the maximum orthogonal rotation,the cumulative contribution rate was 61.480%. Cronbach alpha coefficient for the overall scale was 0.918, the split-half reliability coefficient was 0.858.Conclusions:The Chinese version of of FINC-NA has been proved to be reliable and valid which can be used to objectively evaluate the nurses′ attitudes toward families′ importance in nursing care in China.

Experience and reflection on the construction of medical alliances in a government and hospital partnership model / 中华医院管理杂志

Active exploration for building a model of medical alliances fitting local needs, proves imperative for the functional positioning of medical institutions, promoting inter-institutional cooperation and enhancing the capacity of primary medical services. The authors described experiences and insights of the No.1 Affiliated Hospital and the People′s government of Quangang District in their partnership, and building a brand new model of medical alliance between a hospital and a local government. Also presented are characteristics of such a model, and analysis of operational data in benefiting the people. They held that such a partnership is a worthy attempt in the healthcare reform, by means of building medical alliances between local government and provincial hospitals. Such a practice can provide valuable references for promoting government-hospital synergy, elevating primary healthcare capacity and advancing the hierarchical medical system.

Epidemiology of allergic rhinitis in children in grassland of Inner mongolia / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the self-reported prevalence, clinical characteristics, complications of allergic rhinitis (AR) and the sensitization of outdoor air pollen allergens in children in the Inner mongolia grassland region.@*Methods@#A multistage, stratified and random clustered sampling with a face-to-face interview survey study in children from 0 to 17 years old was performed together with 10 common allergen skin prick tests (SPT) and measurements of the daily pollen count in 6 regions in the Inner mongolia grassland region from May to August of 2015. SAS 9.4 software was used for data analysis.@*Results@#A total of 2 443 subjects completed the study. The self-reported prevalence of AR was 26.6%. The prevalence of boys was higher than that of girls (28.8% vs 24.3%, χ2=6.157, P<0.05). Subjects from urban areas showed higher prevalence than rural areas (34.7% vs 18.8%, χ2=79.107, P<0.05). There was significant regional difference in the prevalence of AR among the six areas investigated (χ2=221.416, P<0.05). The main clinical symptoms of AR were sneezing (88.2%) and nasal congestion (78.6%). Among combined diseases, asthma accounted for 16.5% (107/650), rhinoconjunctivitis accounted for 47.9% (311/650). The peak season of AR was April and July, with the top SPT positive allergens of Artemisia species and chenopodium in this area.@*Conclusions@#The prevalence AR in children in the Inner mongolia grassland region is extremely high. Sneezing is the main clinical symptom. Rhinoconjunctivitis is the most common combined disease. High summer and autumn pollen exposure is the main cause of AR.

Analysis of positive features of cytomegalovirus antibody in children aged 0-12 years in Shandong / 国际检验医学杂志

Objective To analyze the positive features of cytomegalovirus antibodies in children aged 0-12 years in Shandong.Methods 1 429 inpatients and outpatiens w ho came to Shandong Provincial Hospital Affil-iated to Shandong University from January 2014 to December 2016 were enrolled in the study.Cytomegalovir-us IgG and IgM antibodies were detected by chemiluminescence.SPSS21.0 software was used for statistical a-nalysis.Results The positive rate of IgG and IgM antibody of cytomegalovirus was 89.36% and 16.59% re-spectively,and the positive rate of IgG antibody of cytomegalovirus in male was 88.04%,which was signifi-cantly lower than 91.32% in female (P<0.05).The positive rate of cytomegalovirus IgM antibody in male was 14.07%,which was significantly lower than 20.31% in female (P<0.05).The positive rate of IgG anti-body of cytomegalovirus was the lowest in 6-12 months age group ( 73.68%),the highest in 0-<6 months age group (92.73%);cytomegalovirus IgM antibody positive rate was the lowest in 4-12 year-old age group (10.26%),and the highest in 1-3 year-old age group (21.57%).The positive rate of IgM antibody of cyto-megalovirus was the highest in winter (22.92%) and the lowest in autumn (11.11%),and the differences of positive rate between the four seasons were statistically significant (P<0.05).A total of 4 cytomegalovirus antibody combination patterns were detected,with the most common type of cytomegalovirus IgG antibody positive and cytomegalovirus IgM antibody double negative,accounting for 73.27%.Conclusion There were differences in sex,age and season in the positive rates of CMV antibody in Shandong area.Prevention and con-trol of cytomegalovirus infection in children should be strengthened.

Clinical effect of Smecta and Kangfuxin Liquid in the treatment of patients with stomatitis and oral ulcer / 中国基层医药

Objective To explore the clinical effect of Smecta combined with Kangfuxin Liquid in the treatment of stomatitis and oral ulcer.Methods From January 2015 to April 2017,102 patients with stomatitis and oral ulcers in Heji Hospital Affiliated to Changzhi Medical College were selected and randomly divided into observation group and control group according to the digital table.The patients in the control group were treated with stomatitis/oral ulcer sprays.The patients in the observation group were treated with Smecta combined with Kangfuxin Liquid.The therapeutic effect of the two groups was evaluated and analyzed.Results The overall therapeutic effect of the observation group(92.16％)was significantly better than that of the control group(72.55％),the difference was statistically significant(χ2=9.259,P<0.05).The mean ulcer and pain scores of the observation group were significantly lower than those of the control group(t1=-4.362,t2=-5.174,all P<0.05).Conclusion The combination of Kangfuxin Liquid and Smecta in the treatment of stomatitis and oral ulcers can effectively promote ulcer surface repair,help to reduce the local swelling and pain,and has positive role in improving patients'compliance and quality of life,it is recommended in clinical.

RGO and Three-Dimensional Graphene Networks Co-modified TIMs with High Performances.

With the development of microelectronic devices, the insufficient heat dissipation ability becomes one of the major bottlenecks for further miniaturization. Although graphene-assisted epoxy resin (ER) display promising potential to enhance the thermal performances, some limitations of the reduced graphene oxide (RGO) nanosheets and three-dimensional graphene networks (3DGNs) hinder the further improvement of the resulting thermal interface materials (TIMs). In this study, both the RGO nanosheets and 3DGNs are adopted as co-modifiers to improve the thermal conductivity of the ER. The 3DGNs provide a fast transport network for phonon, while the presence of RGO nanosheets enhances the heat transport at the interface between the graphene basal plane and the ER. The synergy of these two modifiers is achieved by selecting a proper proportion and an optimized reduction degree of the RGO nanosheets. Moreover, both the high stability of the thermal conductivity and well mechanical properties of the resulting TIM indicate the potential application prospect in the practical field.

The Role of PP1 in the Cochlea of Mimetic Aging Mice Induced by D -galactose / 听力学及言语疾病杂志

Objective This study was designed to investigate the expression and potential role of the protein phosphatase 1 (PP1) impairment in D -galactose-induced inner ear aging mouse model .Methods Forty Kunming mice were randomly divided into two groups :the control group and D -galactose group ,20 mice for each .The D-galactose group mice were treated with a daily subcutaneous injection of the D -galactose solutions (800 mg · kg -1 · d-1 ) or an equal volume of normal saline(for the control group) in the nape back for 8 weeks .Eight weeks after D-galactose administration ,the effects of were measured by total Superoxide Dismutase (SOD) activity and Malon-dialdehyde (MDA) level in plasma .Immunofluoresence was performed to detect the location of the PP1 expression in the cochlea .Real-time PCR was performed to detect the level of PP1 mRNA in cochlea .A Western blot analysis was performed to analyze the protein levels of protein phosphates 1 nuclear targeting subunit (PNUTS) ,PP1 and caspase-3 in the inner ear .Results The MDA level was more significantly increased in the D -galactose group than in the control group ;however ,the total SOD activity was significantly decreased in the plasma of D -galactose- induced aging mice(P<0 .01) .The results showed that PP1 was predominantly localized in the nucleus and cyto-plasm of the hair cell ,spiral ganglion cell and stria vascularis cell .And the protein levels of PP1 and caspase-3 sig-nificantly increased ,and the level of PNUTS was decreased in the cochlea of the D -galactose group when compared to the control group .Conclusion PP1 contributes to the development of D -galactose-induced aging mice .

Effect of dexmedetomidine combined with sufentanil on postoperative analgesia and the vascular crisis in patients undergoing free flap transplantation / 中国医师进修杂志

Objective To investigate the effect of dexmedetomidine combined with sufentanil on postoperative analgesia and the vascular crisis in patients undergoing free flap transplantation. Methods Forty patients with ASA physical statusⅠ-Ⅱhaving underwent free flap transplantation were divided into groupⅠand groupⅡaccording to the random digits table method with 20 cases each. The drugs of patient controlled intravenous analgesia (PCIA) in groupⅠwere sufentanil 1.0μg/(kg·d)+tropisetron 5 mg/100 ml, and the drugs of PCIA in group Ⅱ were sufentanil 1.0 μg/(kg · d) +dexmedetomidine 1.0 μg/(kg · d) + tropisetron 5 mg/100 ml. The PCIA pump was set in 2 groups as follows: continuous perfusion rate 2 ml/h, single bolus 2 ml, lockout time 15 min. The visual analogue score (VAS), Ramsay sedation score, press number of PCIA pump within 48 h after operation, satisfaction score after operation, untoward reaction and vascular crisis were recorded. Results The VAS at 6, 12, 24 and 48 h after operation in group Ⅱ were significantly lower than those in group Ⅰ: (2.18 ± 0.41) scores vs. (3.00 ± 0.63) scores, (2.64 ± 0.51) scores vs. (3.82 ± 0.60) scores, (2.55 ± 0.52) scores vs. (3.36 ± 0.51) scores and (2.27 ± 0.47) scores vs. (3.09 ± 0.70) scores, the Ramsay sedation scores were significantly higher than those in group Ⅰ: (2.42 ± 0.51) scores vs. (2.00 ± 0.58) scores, (2.74 ± 0.45) scores vs. (2.11 ± 0.57) scores, (2.58 ± 0.51) scores vs. (2.05 ± 0.52) scores and (2.53 ± 0.51) scores vs. (2.00 ± 0.47) scores, and there were statistical differences (P0.05). Conclusions Dexmedetomidine can relieve anxiety and nervousness, reduce postoperative consumption of sufentanil, and decrease the incidence of nausea and vomiting. In addition, dexmedetomidine does not affect the incidence of vascular crisis.