Effectiveness of acupoint application of Xiaozhong Zhitong Tie on diarrhea in patients: a retrospective cohort study in China.

OBJECTIVE: To provide the evidence for the efficacy of acupoint application (AA) for patients with diarrhea in a real-world setting. METHODS: This study is a national multicenter retrospective cohort study. Our study consecutively collected outpatient medical records of patients with diarrhea from hundreds of primary hospitals nationwide registered in Chun Bo Wan Xiang cloud platform from 22nd August, 2020 to 5th November, 2020. The patients were divided into the treatment group and the control group according to patient's condition and willingness. The control group was treated with Western Medicine, oral Chinese Medicine decoction, or both. The treatment group was added with AA based on the control group. Multiple logistic regression was used to evaluate the independent efficacy of AA in diarrheal recovery on the 3rd, 7th, 14th and 28th day. As a next step, we also performed stratified analysis and likelihood ratio test (LRT). Sensitivity analyses included propensity score matching (PSM), four PSM-related analyses and E-value. RESULTS: The treatment group showed better efficacy than the control group on the 14th and 28th day [the 14th day: = 1.58, 95% (1.15, 2.19), 0.005; the 28th day: = 2.03, 95% (1.43, 2.88), < 0.001]. No difference was observed in efficacy of AA for the treatment of diarrhea among the subgroups ( > 0.05). PSM-related analyses confirmed the efficacy of AA in diarrheal recovery. The findings are unlikely to be nullified by an unmeasured confounding variable according to the results of E-values. CONCLUSIONS: The efficacy in the treatment group was significantly more improved than that in the control group on the 14th and 28th day.

Effects of lattice superpulsed CO 2 laser combined with asiaticoside cream ointment on repair of facial depression acne scar / 中华医学美学美容杂志

Objective:To investigate the effect of lattice superpulsed CO 2 laser combined with asiaticoside cream ointment on the repair of facial depression acne scar. Methods:A total of 124 patients with facial acne depression scar who visited the dermatology department of Zhengzhou People's Hospital from January 2019 to December 2020 were selected as subjects, including 60 males and 64 females, aged 16-38 (27.2±4.8) years. According to the random number table, the patients were divided into the control group ( n=62) and observation group ( n=62). The control group were treated with lattice superpulsed CO 2 laser, and the observation group were treated with lattice superpulsed CO 2 laser combined with asiaticoside cream ointment for 6 months. The therapeutic efficacy, Vancouver scar scale (VSS), ECCA score, skin barrier related indicators, pain duration, healing time, delayed duration and adverse reactions were compared between the two groups. Results:The total effective rate in the observation group (91.94%) was significantly higher than that in the control group (77.42%) (χ 2=5.04, P<0.05), pain duration, scab formation time, scab removal time, complete healing time, delay period and the incidence of adverse reactions were significantly lower than those in the control group [(2.76±1.04) h, (2.64±1.03) d, (6.18±1.47) d, (8.87±1.75) d, (7.89±2.16) d, 3.23% vs. (4.11±1.29) h, (3.87±1.14) d, (7.24±1.56) d, (11.05±1.93) d, (10.52±3.01) d, 12.90%, detection value = 6.42, 6.30, 3.90, 6.59, 5.59, 3.92, P<0.05]. After treatment, the VSS scale and ECCA score in the observation group were significantly lower than those in the control group (5.71±1.06, 39.12±10.64 vs. 6.42±1.17, 42.61±11.51, t=3.54, 2.26, P<0.05). After treatment, the water content of cuticle in the observation group was significantly higher than that in the control group [(40.02±14.14) vs. (34.35±11.50) AU, t=2.45, P<0.05], and transepidermal water loss, lactic acid stimulation test score and cuticle protein content were significantly lower than those in the control group [(19.07±5.70) g/(h·m 2), (2.62±1.27) score, (30.12±10.63) μg vs. (21.39±6.51) g/(h·m 2), (3.25±1.89) score, (35.10±11.19) μg, t=2.11, 2.18, 2.54, P<0.05]. Conclusions:Lattice superpulsed CO 2 laser combined with asiaticoside cream ointmentis can effectively treat acne scar and reduce adverse reactions, and the curative effect is better than single laser treatment.

XU Fengqin's Experience in Treating Hypertension in the Elderly based on the Theory of “Combination of Disease and Symptoms” / 中医杂志

This paper summarized the clinical experience of XU Fengqin in the treatment of hypertension in the elderly. It is believed that the basic pathogenesis of hypertension in the elderly is liver and kidney depletion， and the key is ascendant hyperactivity of liver yang and spleen failing to transport. Therefore， the theory of “combination of disease and symptoms” is put forward that the four common clinical symptoms of hypertension in the elderly， including morning hypertension， non-dipper hypertension with abnormal circadian rhythm， postprandial hypotension and orthostatic hypotension， should be differentiated and treated with prescription in accordance with the characteristics of the corresponding pathogenesis. Specifically， the pathogenesis of morning hypertension is mainly liver-kidney yin deficiency and ascendant hyperactivity of liver yang， for which the treatment method of enriching liver and boosting kidney， calming the liver and subduing yang is suggested， and Qingxuan Jiangya Decoction （清眩降压汤） in modifications can be used. For non-dipper hypertension with abnormal circadian rhythm， the pathogenesis is mainly phlegm-dampness obstruction and clear yang failing to ascend， and treatment method should be dissolving phlegm and dispelling dampness， calming the liver and extinguishing wind， with Banxia Baizhu Tianma Decoction and Modified Honglong Xiahai Decoction （半夏白术天麻汤合加味红龙夏海汤） in its modifications. Regarding postprandial hypotension and orthostatic hypotension， the pathogenesis is mainly spleen-stomach depletion and clear yang failing to ascend， and thus the method of supplementing the center and boosting qi， raising yang and lifting the sunken is advised with Buzhong Yiqi Decoction （补中益气汤） or Yiqi Congming Decoction （益气聪明汤） in the modifications.

Generation of Mlk3 KO mice by CRISPR/Cas9 and its effect on blood pressure / 生物工程学报

To explore the effect of Mlk3 (mixed lineage kinase 3) deficiency on blood pressure, Mlk3 gene knockout (Mlk3KO) mice were generated. Activities of sgRNAs targeted Mlk3 gene were evaluated by T7 endonuclease I (T7E1) assay. CRISPR/Cas9 mRNA and sgRNA were obtained by in vitro transcription, microinjected into zygote, followed by transferring into a foster mother. Genotyping and DNA sequencing confirmed the deletion of Mlk3 gene. Real- time PCR (RT-PCR), Western blotting or immunofluorescence analysis showed that Mlk3KO mice had an undetectable expression of Mlk3 mRNA or Mlk3 protein. Mlk3KO mice exhibited an elevated systolic blood pressure compared with wild-type mice as measured by tail-cuff system. Immunohistochemistry and Western blotting analysis showed that the phosphorylation of MLC (myosin light chain) was significantly increased in aorta isolated from Mlk3KO mice. Together, Mlk3KO mice was successfully generated by CRISPR/Cas9 system. MLK3 functions in maintaining blood pressure homeostasis by regulating MLC phosphorylation. This study provides an animal model for exploring the mechanism by which Mlk3 protects against the development of hypertension and hypertensive cardiovascular remodeling.

Effect of Huatan Tongluo Prescription on Vulnerability of Carotid Atherosclerotic Plaque in Hypertension / 中国实验方剂学杂志

ObjectiveTo evaluate the effect of Huatan Tongluo prescription on the vulnerability of atherosclerotic plaques in the carotid arteries of patients with hypertension of phlegm-stasis combination syndrome. MethodA total of 132 eligible patients were randomly divided into an observation group （66 cases） and a control group （66 cases）. The control group received oral atorvastatin calcium tablets and enteric-coated aspirin tablets， while the observation group received Huatan Tongluo prescription in addition to the treatment received by the control group. The treatment duration was 6 months. A carotid artery ultrasound examination was performed to record the number of plaques， the maximum plaque area， the maximum plaque cross-sectional thickness， and the intima-media thickness （IMT） of the carotid artery. Crouse score， plaque vulnerability score， and phlegm-stasis combination syndrome score were assessed. Blood lipid levels ［total cholesterol （TC）， triglyceride （TG）， high-density lipoprotein cholesterol （HDL-C）， and low-density lipoprotein cholesterol （LDL-C）］， inflammatory markers ［neutrophil-to-lymphocyte ratio （NLR）， monocyte-to-lymphocyte ratio （MLR）， interleukin-6 （IL-6）， and high-sensitivity C-reactive protein （hs-CRP）］， vascular endothelial function ［endothelin-1 （ET-1）， von Willebrand factor （vWF）， and nitric oxide （NO）］， and relevant proteins ［pentraxin 3 （PTX3） and galectin-3 （Gal-3）］ levels were measured. Safety evaluation was conducted， and comparisons were made in terms of carotid artery stenosis rate， plaque regression efficacy， and traditional Chinese medicine （TCM） syndrome efficacy. ResultCompared with the results before treatment， both groups showed significant reductions in IMT， plaque number， maximum plaque area， and maximum plaque cross-sectional thickness （P<0.05）. After treatment， the observation group exhibited more significant reductions in the above indicators compared with the control group （P<0.05）. After treatment， Crouse scores， plaque vulnerability scores， and phlegm-stasis combination syndrome scores in both groups were lower than those before treatment （P<0.05）. After treatment， the observation group had lower scores in these indicators than the control group （P<0.05）. In terms of blood lipid levels， both groups showed decreases in TC， TG， and LDL-C levels， and an increase in HDL-C levels after treatment compared to those before treatment （P<0.05）. The observation group exhibited greater improvements in these lipid parameters than the control group （P<0.05）. Inflammatory markers NLR， MLR， IL-6， and hs-CRP significantly decreased in both groups after treatment compared with those before treatment （P<0.05）. The observation group showed more significant reductions in these markers than the control group after treatment （P<0.05）. After treatment， both groups demonstrated decreases in levels of ET-1， vWF， PTX3， and Gal-3， along with an increase in NO levels compared with those before treatment （P<0.05）. The observation group showed more significant improvements in these markers than the control group after treatment （P<0.05）. After treatment， the observation group had a lower carotid artery stenosis rate than the control group （P<0.05）. The plaque regression efficacy rate was 51.72% （30/58） in the observation group， and the total effective rate of TCM syndrome was 84.48% （49/58）， both of which were higher than 18.64% （11/59） and 52.54% （31/59） in the control group （χ²=10.061， 13.799， P<0.05）. No adverse reactions related to the Huatan Tongluo prescription were observed during the treatment period. ConclusionIn addition to statin therapy， Huatan Tongluo prescription can effectively reverse carotid artery atherosclerotic plaques in patients with hypertension and carotid artery stenosis， reduce plaque vulnerability， exhibit lipid-lowering and anti-inflammatory effects， and improve vascular endothelial function. The treatment demonstrates favorable clinical efficacy and safety. Therefore， it is very worthy of clinical promotion and application.

Innate immune sensing of self-derived double-stranded RNA by RIG-I-MAVS-TNF-α regulates the survival and senescence fate of SARS-2-S syncytia

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains an important health threat. Syncytial formation by infected cells mediated by the SARS-CoV-2 spike protein (SARS-2-S) is a hallmark of COVID-19-associated pathology. Although SARS-CoV-2 infection evokes cellular senescence, as in other viruses, the direct link between SARS-2-S-induced syncytia with senescence in the absence of viral infection and their senescence fate determinants remain unknown. Here, we show that syncytia formed by cells expressing exogenously delivered SARS-2-S exhibited a senescence-like phenotype in vitro and that SARS-2-S mRNA induced senescence phenotype in vivo. Extracellular vesicles (EVs) containing SARS-2-S also induced senescent syncytium formation independent of the de novo synthesis of SARS-2-S. Mechanistically, we show that the accumulation of endogenous dsRNA, partially that whose formation is induced by activation of the unfolded protein response (UPR), in SARS-2-S syncytia triggers RIG-I-MAVS signalling to drive the TNF--dependent survival and senescence fate of SARS-2-S syncytia. Our findings suggest that the fusogenic ability of SARS-2-S might contribute to the side effects of particular COVID-19 vaccines or perhaps long COVID-19 syndrome and provide insight into how these effects can be prevented.

Experience on prevention and control management of the pediatric emergency department during the pandemic of Omicron variant of novel coronavirus in Shanghai in 2022 / 中国小儿急救医学

Objective:To summarize the experience on accurate prevention and control of children′s emergency department during the epidemic of novel coronavirus Omicron variant.Methods:We retrospectively analyzed the strategies and management experience of emergency prevention and control of novel coronavirus infection in emergency department at Children′s Hospital of Fudan University from March to May 2022.Results:As a designated hospital for treating pediatric patients who contracted novel coronavirus in Shanghai, the emergency department in our hospital was confronted with the dual pressure of critical patients treatment and pandemic prevention and control.We carefully studied a series of laws and regulations, as well as the newest edition of Chinese clinical guidance for novel coronavirus pneumonia diagnosis and treatment, and combined with the characteristics of novel coronavirus infection in children, then formulated the independent emergency department, fever clinics and novel coronavirus clinics; Updated the emergency department pre-examination triage process, the precautions pratice of clinical stuffs and disfection strategy, and established the second emergency department.From the beginning of March to the end of May 2022, a total of about 12 000 patients were admitted to the emergency department in our hospital, including 704 patients in the resuscitation room, 652 patients in the observation room, and 164 patients in the emergency ward.There were six patients with novel coronavirus infection in the emergency department.Neither nosocomial infection nor occupational exposure occurred.Conclusion:After 3 months of practice, the results showed that it can fully guarantee the timely treatment of critically ill children and achieved zero cross-infection in the hospital, which has important reference significance for the treatment of children, epidemic prevention, control during the novel coronavirus epidemic.

GP73 is a glucogenic hormone regulating SARS-CoV-2-induced hyperglycemia

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection induces new-onset diabetes and severe metabolic complications of pre-existing diabetes. The pathogenic mechanism underlying this is incompletely understood. Here, we provided evidence linking circulating GP73 with the exaggerated gluconeogenesis triggered by SARS-CoV-2 infection. We found that SARS-CoV-2 infection or glucotoxic condition increased the cellular secretion of GP73. Secreted GP73 trafficked to the liver and kidney to stimulate gluconeogenesis through cAMP/PKA pathway. By using global phosphoproteomics, we found a drastic remodeling of PKA kinase hub exerted by GP73. Notably, COVID-19 patients showed pathologically elevated plasma GP73, and neutralization of the secreted GP73 inhibited enhanced PKA signaling and glucose production associated with SARS-CoV-2 infection. GP73 blockade also reduced gluconeogenesis and lowered hyperglycemia in type 2 (T2D) diabetic mice. Therefore, our findings provide novel insight into the roles of GP73 as a key glucogenic hormone and mechanistic clues underlying the development of SARS-CoV-induced glucose abnormalities.

Detection of antibodies against SARS-CoV-2 as a serologic marker of infection in patients with COVID-19 / 中国输血杂志

【Objective】 To investigate the diagnostic value of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) specific antibodies IgM and IgG on coronavirus disease 2019 (COVID-19). 【Methods】 1) The test results of SARS-CoV-2 IgM/IgG antibodies and nucleic acid(NAT), which were tested by colloidal gold test and fluorescent quantitative PCR respectively, were collected from 145 febrile outpatients during early March, 2020, named Fever group, in which retrospective analysis and paired chi-square test were performed. 2) 612 cases of SARS-CoV-2 IgM/IgG antibodies test results, which were done on March 5, 2020, were collected. They were named COVID-19 group (Our hospital was provisionally assigned as a specialized hospital for COVID-19, and 1500 COVID-19 patients admitted to our hospital from February 12, 2020 to March 18, 2020). The SARS-CoV-2 IgM/IgG antibodies and NAT were respectively tested on the 30th and the 60th day after the date of discharge. The clinical application values of the antibodies was clarified by statistical analysis. 【Results】 1) In the fever group, the positive rate of SARS-CoV-2 IgM, IgG and IgM+ IgG antibodies were 26.21% (38/145), 54.48% (79/145) and 26.21% (38/145), respectively(P<0.01), and the positive rate of NAT was 4.14% (6/145), which was lower than that of antibody (P<0.01). One (1/145, 0.69%) positive NAT was implicated in initially negative IgM and IgG antibodies samples. 2) In the COVID-19 group, the positive rate of IgM antibody was low (5%) and IgG antibody was high (65%) during 2~14 days after infection, and stably increased during the 15~56 days [IgM 47.68%(277/581) vs IgG 94.15% (547/581) ], then both decreased after 57 days. The positive rates of IgM antibody and IgG antibody were 45.8% (280/612) and 93.1% (570/612) in 612 patients during hospitalization. 15 patients′ data after dischange were not collected as they were later transferred to Huoshenshan Hospital for treatment. The coronavirus NAT results of the rest 597 COVID-19 patients, tested on the 30th and 60th days after the date of discharge, were negative, and the positive rates of IgG antibody and IgM antibody were still ≥80% and ≥40% respectively at the second month after discharge. 【Conclusion】 IgM, IgG antibody against SARS-CoV-2 can be well detected by Colloidal gold method(Innovita), whose positive rate is higher than that of NAT. IgG antibody is produced earlier than IgM, and it keeps high positive rate and persists for a long time. The combination of colloidal gold antibody test and NAT can improve the diagnose rate of COVID-19 and the exclusion of suspected cases.

SARS-CoV-2 manipulates the SR-B1-mediated HDL uptake pathway for its entry

The recently emerged pathogenic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly, leading to a global COVID-19 pandemic. Binding of the viral spike protein (SARS-2-S) to cell surface receptor angiotensin-converting enzyme 2 (ACE2) mediates host cell infection. In the present study, we demonstrate that in addition to ACE2, the S1 subunit of SARS-2-S binds to HDL and that SARS-CoV-2 hijacks the SR-B1-mediated HDL uptake pathway to facilitate its entry. SR-B1 facilitates SARS-CoV-2 entry into permissive cells by augmenting virus attachment. MAb (monoclonal antibody)-mediated blocking of SARS-2-S-HDL binding and SR-B1 antagonists strongly inhibit HDL-enhanced SARS-CoV-2 infection. Notably, SR-B1 is co-expressed with ACE2 in human pulmonary and extrapulmonary tissues. These findings revealed a novel mechanism for SARS-CoV-2 entry and could provide a new target to treat SARS-CoV-2 infection.

Cholesterol Metabolism--Impact for SARS-CoV-2 Infection Prognosis, Entry, and Antiviral Therapies

In this study, we specifically addressed the connection between the SARS-CoV-2 virus with host cholesterol metabolism. Plasma lipid profile was measured in 861 COVID-19 patients classified as mild (n=215), moderate (n=364), severe (n=217) or critical (n=65) and 1108 age- and sex-matched healthy individuals. We showed that the levels of both TG and HDL-C were significantly lower in patients with severe disease than in patients with moderate or mild disease. After successful treatment, cholesterol metabolism was reestablished in patients with SARS-CoV-2 infection. The serum concentrations of TC and HDL-C can be used as indicators of disease severity and prognosis in COVID-19 patients.

Improved efficacy of nalbuphine combined with propofol in artificial abortion / 中华麻醉学杂志

Objective:To evaluate the improved efficacy of nalbuphine combined with propofol in artificial abortion.Methods:One hundred American Society of Anesthesiologists physical status Ⅰor Ⅱ patients, aged 20-43 yr, weighing 50-80 kg, undergoing elective artificial abortion, were divided into 2 groups ( n=50 each) using a random number table method: propofol group (group P) and nalbuphine combined with propofol group (group NP). Phloroglucinol 40 mg was intramuscularly injected at 15 min before surgery.Propofol 2.0 mg/kg was intravenously injected in group P. In group NP, nalbuphine 0.1 mg/kg was intravenously injected, and 2 min later propofol 2.0 mg/kg was intravenously injected.The operation was started after the eyelash reflex disappeared.When operation was affected due to the body movement occurred during operation, an increment of propofol 0.5 mg/kg was given.Visual analogue scale (VAS) score was used to assess the degree of uterine contraction pain during the awake period and the highest degree of uterine contraction pain during the recovery period.The consumption of propofol, development of adverse effects and surgeon′s satisfaction with the anesthetic effect were recorded. Results:Compared with group P, the consumption of propofol was significantly reduced, VAS scores during the awake period and the highest VAS score during the recovery period were decreased, the incidence of body movement that affected operation was decreased (16%/2%), and the surgeon′s satisfaction with the anesthetic effect was increased in group NP ( P<0.05). No adverse cardiovascular events and respiratory depression during operation and postoperative nausea and vomiting was found in the two groups. Conclusion:Intravenous injection of nalbuphine 0.1 mg/kg combined with propofol 2.0 mg/kg can be safely and effectively used for the comfort medical treatment of artificial abortion, and the combination has a significant optimized effect than propofol alone.

Clinical features of 9 children with osteomyelitis caused by Streptococcus pneumonia / 中华实用儿科临床杂志

Objective:To investigate the clinical features, diagnosis, treatment and prognosis of children with osteomyelitis caused by Streptococcus pneumonia. Methods:The demographic characteristics, diagnosis, clinical manifestations, imaging features, treatment and short-term prognosis of Streptococcus pneumonia osteomyelitis cases in 18 children′s hospitals from January 2012 to December 2017 were retrospectively collected and analyzed. Results:A total of 9 cases were enrolled, with a median age of 1 year and 3 months.Four children had underlying diseases.The main manifestations were local swelling, pain, limited mobility (9 cases) and fever (8 cases). Sites of infection included humerus (4 cases), femur (3 cases) and tibiofibula (2 cases), and 8 cases were complicated with septic arthritis; The laboratory tests showed increased white blood cells (8 cases, median 22.02×10 9/L), C-reactive protein (7 cases, median 55.44 mg/L) and erythrocyte sedimentation rate (6 cases, median 70 mm/1 h) of those patients.Five patients received monotherapy in the initial treatment regimen with cephalosporins. Then the therapeutic schedules were adjusted according to the culture and antibiotic sensitivity. All patients were treated with puncture, incision drainage or fenestrating decompression.Eight patients were cured and discharged finally. Conclusions:Streptococcus pneumonia osteomyelitis is more common in younger children and may have no risk factors.The common infection site is long bone metaphysis, and those patients are easily complicated with septic arthritis.Antibiotic combined with surgical treatment are crucial to a good outcome.

Influence of End Shapes on Biomechanical Behavior of the Stent-Esophagus Coupling System / 医用生物力学

Objective To investigate the influence of different end shapes of esophageal stents on the mechanical behavior of the stent-esophagus system. Methods Through finite element simulation, the mechanical behavior of the coupling system between braided esophageal stents with different end shapes (straight-tube-shaped, cup-spherical-shaped, double-trumpet-shaped) and the esophageal cavity was analyzed. The influences of bare stents and covered stents with three different end shapes on stress distributions in the inner wall of the esophagus and on dilatation of the esophageal stenosis zone were compared. Results The reduction in stenosis rate caused by the bare stent was larger than that of the covered stent. Moreover, the equivalent stress and the contact stress caused by the bare stent were much larger than those of the covered stent. Different end shapes had a significant influence on the stress occurring in the healthy esophageal zone. Stress concentration occurred in the zones where the esophagus contacted the central part of the cup-shaped end and the edge of the double-trumpet-shaped end. The braided esophageal stents with three different end shapes all had good apposition.Conclusions Different end shapes of stents cause different stress states in the esophagus. A larger stress involves a higher probability of occurrence of esophageal tissue hyperplasia, but a smaller possibility of stent migration. Therefore, understanding the effect of the end shapes on stent performance can provide important theoretical references for optimization design of the braided stent and its clinical selection.

A multicenter clinical study on 1 138 cases of invasive pneumococcal disease in children from 2012 to 2017 / 中华儿科杂志

Objective@#To explore the clinical features, the serotype distribution and drug resistance of the isolates in patient with invasive pneumococcal disease (IPD).@*Methods@#By retrieving the laboratory information system in 18 children′s hospitals from 2012 to 2017, the children with IPD were enrolled. Streptococcus pneumoniae (Spn) must be isolated from the sterile sites (blood, cerebrospinal fluid, hydrothorax and joint effusion etc.). The clinical characteristics, serotype, drug resistance, treatment and prognosis were reviewed and analyzed. According to the telephone follow up results, the patients were divided into death group and recovered group. The index as an independent risk factor of mortality was demonstrated by multivariate logistic regression analysis.@*Results@#There were 1 138 children with IPD, including 684 male and 454 female. The proportion of male to female was 1.5∶1. The age ranged from one day to 16 years. The median age was 1 year 3 month. The majority was under 5 years of age (89.3%, n= 1 016), especially under 2 years of age (61.9%, n=704). In all cases, 88.2% (n=1 004) were community acquired infection. The infections included meningitis (n=446, 39.2%), pneumonia with bacteremia (n=339, 29.8%), and bacteremia without focus (n=232, 20.4%). Underlying diseases were found in 242 cases (21.3%). Co-infections were determined in 62 cases (5.4%) with mycoplasma, 27 cases (2.4%) with adenovirus and 34 cases with influenza virus (3.0%). The penicillin insensitivity (PNSP) rates in meningitis and non-meningitis isolates were 69.5% (276/397) and 35.9% (221/615), respectively. There were 81 strains serotyped, in which 93.8% (76/81) were covered by 13-valent protein-polysaccharide conjugate vaccine (PCV13). In the 965 patients who were followed up by phone call, 156 cases (16.2%) were confirmed dead. The independent risk factors for the death were under 2 years of age (OR=2.143, 95%CI 1.284-3.577, P=0.004), meningitis (OR=3.066, 95%CI 1.852-5.074, P<0.01), underlying disease (OR=4.801, 95%CI 2.953-7.804, P<0.01), septic shock(OR=3.542, 95%CI 1.829-6.859, P<0.01), disseminated intravascular coagulation (DIC) (OR=4.150, 95%CI 1.468-11.733, P=0.007), multiple organ failure (OR=12.693, 95%CI 6.623-24.325, P<0.01) and complications of central nervous system (OR=1.975, 95%CI 1.144-3.410, P=0.015).@*Conclusions@#Most children with IPD were under 5 years of age, having underlying diseases and acquired the infection in community. The independent risk factors for death were under two years old, meningitis, underlying diseases and multiple organ failure. The problem of drug resistance was severe. The universal immunization of PCV13 would be effective to prevent IPD in Chinese children.

Multistage analysis method for detection of effective herb prescription from clinical data / 医学前沿

Determining effective traditional Chinese medicine (TCM) treatments for specific disease conditions or particular patient groups is a difficult issue that necessitates investigation because of the complicated personalized manifestations in real-world patients and the individualized combination therapies prescribed in clinical settings. In this study, a multistage analysis method that integrates propensity case matching, complex network analysis, and herb set enrichment analysis was proposed to identify effective herb prescriptions for particular diseases (e.g., insomnia). First, propensity case matching was applied to match clinical cases. Then, core network extraction and herb set enrichment were combined to detect core effective herb prescriptions. Effectiveness-based mutual information was used to detect strong herb-symptom relationships. This method was applied on a TCM clinical data set with 955 patients collected from well-designed observational studies. Results revealed that groups of herb prescriptions with higher effectiveness rates (76.9% vs. 42.8% for matched samples; 94.2% vs. 84.9% for all samples) compared with the original prescriptions were found. Particular patient groups with symptom manifestations were also identified to help investigate the indications of the effective herb prescriptions.

Subgroup identification based on the Logistic model / 南方医科大学学报

We propose a subgroup identification method based on the Logistic model for data from a two-arm clinical trial with dichotomous outcome variables.In this method, binary Logistic regression models are established for each group to calculate the outcome probabilities of each patient for comparison.According to the established rules, the patients are classified into their corresponding subgroups to establish a multinomial Logistic regression model.We simulated the false rate, correct judgment rate, coincidence rate and model correct judgment rate for different sample sizes and carried out an example analysis.The results of simulation showed that for different sample sizes, the false rates of this method were below 0.07 and the correct judgment rates were all above 0.75 with adequate coincidence rates and model correct judgment rates, demonstrating the effectiveness and reliability of the proposed method for subgroup identification.

Observation on the effect of Xuesaitong in treating cerebral infarction / 中国基层医药

Objective To observe the clinical effect of Xuesaitong on cerebral infarction.Methods A total of 116 patients with cerebral infarction were enrolled in this study.116 patients with cerebral infarction were randomly divided into the conventional group (58 cases) and Xuesaitong group (58 cases) according to the digital table.The conventional group was given conventional treatment.The Xuesaitong group was given Xuesaitong based on the conventional treatment.The changes of neurological deficits,cognitive function improvement and daily life ability score and quality of life scores were compared between the two groups before and after treatment.Results The total effective rate and blood vessel recanalization rate of the Xuesaitong group were 96.55％ and 98.28％,respectively,which were higher than those in the conventional group (84.48％,82.76％,x2 =6.344,4.723,all P ＜0.05).The scores of neurological deficits,cognitive function scores,daily life ability scores and quality of life scores of the Xuesaitong group were (77.91 ± 3.13) points,(94.18 ± 4.21) points,(12.42 ± 2.23) points and (27.21 ± 4.71) points,respectively,which of the conventional groupwere (30.44 ± 3.18) points,(80.01 ± 3.59) points,(20.13 ± 4.19) points,(23.41 ± 3.29) points,respectively.The differences were statistically significant between the two groups (t =5.872,9.76,6.145,9.014,all P ＜ 0.05).Conclusion Xuesaitong in the treatment of cerebral infarction is effective,which can significantly improve the clinical efficacy,reduce the degree of neurological deficits,improve the patients'cognitive function and daily living ability.

Influence of Helicobacter pylori Infection on Diagnostic Performance of Serum Pepsinogens / 胃肠病学

Background:Serum pepsinogens (PGs),as a serologic marker for gastric mucosal lesions,can reflect the functional status of gastric mucosa. Helicobacter pylori (Hp)infection can cause pathological changes in gastric mucosa,and has been reported to influence the serum level of PGs. Aims:To explore the influence of Hp infection on diagnostic performance of serum PGs for gastric mucosal lesions. Methods:The endoscopic findings,biopsy pathology (including Giemsa staining) and serum PGs test in 1216 cases of patients from July 2014 to June 2015 at the First Affiliated Hospital of Jiaxing University were collected. Patients were categorized according to the pathological diagnosis and Hp status,and the results of serum PGs test were analyzed between different groups. Results:When patients were classified by gastric mucosal lesion,no significant differences were found in serum levels of PGⅠ,PGⅡ,ratio for PGⅠ/ Ⅱ (PGR)and proportion of PG-positive (PGⅠ≤70 μg/ L and PGR < 3. 0)patients of different mucosal lesion groups with Hp-positive status (P >0. 05),whereas significant differences were observed in serum levels of PGⅠ,PGⅡ,PGR and proportions of patients with PGⅠ≤70 μg/ L or PGR < 3. 0 of different mucosal lesion groups with Hp-negative status (P < 0. 05). When patients were classified by Hp status,PGⅠ level and PGR were lower and PGⅡ level and proportion of PG-positive patients were higher in Hp-positive patients than in Hp-negative patients in any of the gastric mucosal lesion groups (P < 0. 05 in part of the comparisons). Conclusions:Hp infection is strongly associated with the alterations in serum PGs test,which narrows the differences in PGs between groups with different gastric mucosal lesions and expands that within the same mucosal lesion, subsequently decreasing PGR and increasing the proportion of PG-positive patients. Patients negative for Hp infection may need new cut-off value of serum PGs test to improve the sensitivity for diagnosis of gastric mucosal lesion.

Expression of Ki-67 and PTEN in oral adenoid cystic carcinoma and its clinical significance / 实用肿瘤学杂志

Objective The aims of this study were to determine the expression of Ki-67 and PTEN in oral adenoid cystic carcinoma( OACC) and its relationship with clinicopathological features,and to explore the re-lationship between the expression of Ki-67 and PTEN. Methods Forty cases of oral adenoid cystic carcinoma were collected from the pathological laboratory in our hospital. Another 15 cases of normal gland in patients with oral adenoid cystic carcinoma were selected as the control group. The expression of Ki-67 protein and PTEN in adenoid cystic carcinoma was detected by immunohistochemistry. Results The positive rate of Ki-67 protein in oral adenoid cystic carcinoma was 70%(28/40),which was significantly higher than that in the control group(2/15)(P<0. 05). The positive rate of PTEN in oral adenoid cystic carcinoma was 63%(25/40),which was signif-icantly higher than that in the control group 20%(3/15)(P <0. 05). They were associated with histological types,metastasis,lymph node metastasis and neural invasion,and not correlated with age,gender and tumor loca-tion. The expression of Ki-67 and PTEN in oral adenoid cystic carcinoma may have a significant correlation. Conclusion The expression of Ki-67 and PTEN in adenoid cystic carcinoma is high,and their occurrence and development in adenoid cystic carcinoma play an important role in the process of evolution and metastasis. Ki-67 and PTEN proteins may be markers of oral adenoid cystic carcinoma.