［Abstract］ Objective To investigate the trends of proportion and in-hospital mortality of patients with ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI) over the past 12 years. Methods A retrospective analysis was performed on 4 868 patients, who were hospitalized for acute myocardial infarction (AMI) in the Department of Cardiovasology, Changhai Hospital, Naval Medical University (Second Military Medical University) from Jan. 1, 2007 to Dec. 31, 2018. The annual percentage change (APC) method was used to analyze the changes of the proportion and in-hospital mortality of STEMI and NSTEMI patients. Results Of the 4 868 AMI patients, 3 064 (62.9%) had STEMI and 1 804 (37.1%) had NSTEMI. The proportion of NSTEMI patients significantly increased within the 12 years (APC value 14.0%, P＜0.01), from 15.7% in 2007 to 45.2% in 2018; the proportion of STEMI patients showed a significant decline (APC value －5.5%, P＜0.01), from 84.3% in 2007 to 54.8% in 2018. The in-hospital mortality of AMI patients showed a significantly downward trend (APC value －6.6%, P＜0.05), from 7.0% in 2007 to 4.3% in 2018. The in-hospital mortality of NSTEMI patients also showed a significant decline (APC value －11.9%, P＜0.05), from 13.9% in 2007 to 1.9% in 2018, while that of STEMI patients showed no significant change (APC value －3.8%, P＝0.225). Conclusion Among AMI patients in our hospital from 2007 to 2018, the proportion of NSTEMI patients showed an increasing trend. The in-hospital mortality of NSTEMI patients decreased within the 12 years, while that of STEMI patients did not.

Objective: To retrospectively analyze the allergen characteristics and the onset season of allergic rhinitis (AR) patients in Shanghai, China. Methods: From Jan. 1, 2015 to Dec. 31, 2017, 1 570 suspected AR patients were selected from the Department of Otolaryngology/Head and Neck Surgery, Changzheng Hospital, Naval Medical University (Second Military Medical University). One milliliter of serum was extracted from each patient and the specific immunoglobulin E (IgE) levels of 22 kinds of allergens and total IgE levels were detected using allergen specific IgE antibody detection kit (immunoblotting method). The AR patients were divided into 5-16, 17-39, 40-64 and ≥65 years old groups, and the positive rates of allergens were compared. The number of AR patients with one or more positive allergens was recorded every month, and the seasonal distribution of positive allergen was analyzed. Results: Of the 1 570 suspected AR patients, 143 (9.1%) had elevated serum total IgE, and 1 182 (75.3%) had one or more positive allergens, including 491 (41.5%) with single positive allergen and 691 (58.5%) with two or more positive allergens. Among the 22 kinds of allergens, dust mites (including Dermatophagoides pteronyssinus and Dermatophagoides farinae) were the most common allergens (715 cases, 60.5%), followed by penicillin (239 cases, 20.2%) and Chinese parasol (167 cases, 14.1%). Among the 1 182 AR patients, 17-39 years old was the highest proportion (61.0%, 721 cases). The positive rate of dust mites in the 5-16 years old group was significantly higher than those in the 17-39, 40-64 and ≥65 years old groups (all P<0.05). The prevalence peaks of AR were in Apr., May, Jun., Aug., Sep., Oct. and Nov.; and the numbers of AR patients with one or more positive allergens were 175±21, 156±16, 259±31, 172±15, 176±14, 164±4 and 204±32, respectively, which were significantly higher than the average value (97±42) of 36 months from Jan. 1, 2015 to Dec. 31, 2017 (all P<0.05). The positive detection time of dust mites was mainly in May, Jun., Jul., Aug., Sep. and Nov.; and the numbers of dust mite positive AR patients were 64±11, 113±21, 68±18, 76±15, 70±11 and 89±21, respectively, which were significantly higher than the average value (52±32) of the 36 months (all P<0.05). Conclusion: Dust mites are the most common and main allergens of AR patients in Shanghai, China. The proportion is high in AR patients aged 17-39 years old, and the prevalence peaks are from Apr. to Jun. and from Aug. to Nov..

Objective To explore the prevalence and influencing factors of coronary atherosclerotic heart disease (CHD) in rheumatoid arthritis (RA) patients during past 10 years. Methods A total of 5 426 RA patients were selected from Jan. 1, 2009 to Mar. 20, 2019 in the Tianjin First Central Hospital, and 1 483 osteoarthritis (OA) patients were selected as controls. Basic information, laboratory indicators, prevalence of CHD and related complications, and drug use of RA and OA patients were collected and compared. The influencing factors of CHD prevalence in RA patients were analyzed by logistic regression. Results There was no significant difference in the prevalence of CHD between male and female RA patients (32.1%, 321/1 000 vs 32.3%, 323/1 000; χ2＝0.02, P＝0.90). The prevalence rates of CHD, hyperlipidemia and hypertension in RA patients were significantly increased in the past 10 years (χ2＝115.67, 129.41, 193.81, all P＜0.01), while the prevalence of diabetes mellitus was significantly decreased after 2014 (χ2＝29.99, P＜0.01). After propensity score matching of 1∶1 by age and gender, there was no significant difference in CHD prevalence between the RA and OA patients (P＝0.74). The levels of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin 2 receptor (IL-2R), interleukin 6 (IL-6), high density lipoprotein-cholesterol (HDL-C), rheumatoid factor (RF), anti-cyclic citrullinated peptide (ACCP), D-dimer, fibrinogen (FiB) and creatine kinase-myocardial band (CK-MB), and positive rate of anti-keratin antibody (AKA) were significantly higher in the RA patients than those in the OA patients, while the levels of creatine kinase (CK) and blood glucose were significantly lower than those in the OA patients (all P＜0.05). The levels of ESR, CRP, total cholesterol, low density lipoprotein-cholesterol (LDL-C), triglyceride, immunoglobulin G-rheumatoid factor (IgG-RF), ACCP, FiB, blood glucose and uric acid, and the positive rate of AKA were all significantly higher in the RA patients with CHD than those in the RA patients without CHD, while the levels of HDL-C, immunoglobulin G (IgG), immunoglobulin M (IgM) and 25-hydroxyvitamin D were significantly lower than those in the RA patients without CHD (all P＜0.05). Logistic regression analysis showed that the prevalence of CHD was negatively correlated with the levels of total cholesterol, ACCP, IgG and 25-hydroxyvitamin D, but positively correlated with the levels of IgG-RF and uric acid in PA patients (all P＜0.05). Conclusion In clinical treatment, we should pay more attention to the risk factors of CHD in RA patients so as to select more targeted and effective RA treatment, reducing the risk of CHD and improving the quality of life of patients.

Objective To investigate the efficacy of AI-SONICTM Thyroid system, a version 2.0 artificial intelligence (AI) automatic detection system, in the preoperative ultrasound diagnosis of thyroid nodules, and to evaluate the application value of AI automatic detection system version 2.0 in the differential diagnosis of benign and malignant thyroid nodules by comparing with the subjective diagnosis conclusions of sonographers with different seniorities. Methods A total of 247 patients (325 thyroid nodules) admitted to the Department of General Surgery in our hospital from Aug. 2019 to Jan. 2020 were selected for this study. All patients underwent routine ultrasound examinations by a senior sonographer with 13 years of experience in thyroid ultrasound diagnosis and a junior sonographer with 4 years of work experience. At the same time, the patients were also examined by another sonographer with 20 years of work experience using AI automatic detection system version 2.0, without knowing the diagnosis conclusions of the above two sonographers. Kappa test was used to evaluate the consistency of the results of routine ultrasound examination of sonographers with different seniorities and AI automatic detection system version 2.0 and the postoperative pathological results. Results The postoperative pathology confirmed 229 malignant nodules and 96 benign nodules. The sensitivity, specificity and accuracy in the diagnosis of benign and malignant thyroid nodules were 85.15% (195/229), 66.67% (64/96) and 79.69% (259/325), 93.45% (214/229), 79.17% (76/96) and 89.23% (290/325), and 92.58% (212/229), 71.88% (69/96) and 86.46% (281/325) for junior sonographer, senior sonographer and AI automatic detection system version 2.0, respectively. The Kappa consistency test results showed that the diagnosis result of senior sonographer was highly consistent with the pathological diagnosis result (Kappa value 0.78, P＜0.01), while the diagnosis results of junior sonographer and AI automatic detection system version 2.0 were generally consistent with the pathological diagnosis result (Kappa values 0.55 and 0.74, both P＜0.01). Conclusion The sensitivity, accuracy and specificity of the AI automatic detection system version 2.0 AI-SONICTM Thyroid in diagnosing benign and malignant thyroid nodules are similar to those of routine ultrasound examination by senior sonographers, and the system might be a reliable auxiliary means for preoperative evaluation of benign and malignant thyroid nodules.

Objective To explore the therapeutic effect of endonasal transsphenoidal sellar tumor resection surgery for the treatment of non-functioning pituitary adenoma patients with hyperprolactinemia. Methods A total of 80 non-functioning pituitary adenoma patients with serum prolactin level ＞25 ng/mL and ＜200 ng/mL, who underwent endonasal transsphenoidal sellar tumor resection surgery in the Department of Neurosurgery of our hospital from Jan. 1, 2015 to Dec. 31, 2019, were retrospectively included. The clinical characteristics, surgical methods, postoperative complications, and the relief of postoperative hyperprolactinemia and clinical symptoms were analyzed. The predictive factors of postoperative hyperprolactinemia remission were analyzed using logistic regression. Results Out of the 80 patients, 21 were males and 59 were females. The preoperative prolactin level was 51.11 (25.20-136.52) ng/mL, and the tumor volume was 3.99 (0.23-37.11) cm3. Headache was the most common initial symptom (37.5%, 30/80). There was significant difference in the initial symptoms between the male and female patients (P＝0.031), and the female patients were more likely to present with hypogonadotropic hypogonadism compared with the male patients (28.8%［17/59］vs 9.5%［2/21］). The male patients were significantly more likely to have two or more hormonal axis dysfunctions (47.6%［10/21］vs 15.3%［9/59］, P＝0.025). All the 80 patients received the resection surgery and 88.8% (71/80) of them achieved gross or near total resection. Sixty-five (81.2%) patients had remission of hyperprolactinemia within 3 months after surgery, and the prolactin level was 13.44 (1.74-24.19) ng/mL 3 months after surgery; 15 patients had no remission, and the corresponding prolactin level was 32.69 (25.20-115.23) ng/mL. The prolactin levels before and 1 d after surgery were significantly lower in the remission group than those in the non-remission group (preoperative: 45.47 ［25.20-136.52］ng/mL vs 64.82［33.17-130.88］ng/mL, P＝0.003; postoperative day 1: 13.12［0.60-36.35］ng/mL vs 40.06 ［26.25-118.01］ng/mL, P＜0.01). There were no significant differences in gender, age, tumor volume, surgical methods or extent of tumor resection between the two groups (all P＞0.05). Multivariate logistic regression analysis showed that prolactin level ≤25 ng/mL on postoperative day 1 was an independent predictor of remission of hyperprolactinemia (odds ratio 13.500, 95% confidence interval 3.623-50.298, P＜0.01). The visual defect and headache improvement rates were 87.9% (29/33) and 93.9% (31/33), respectively. Among the 17 female patients with menstrual disorders before surgery, 14 (82.4%) returned to normal menstrual cycles. Conclusion Endonasal transsphenoidal sellar tumor resection surgery is a reliable treatment option for non-functioning pituitary adenoma patients with hyperprolactinemia.

Objective To investigate the correlation between serum 1,5-anhydroglucitol (1,5-AG) and mild cognitive impairment (MCI). Methods According to the diagnostic criteria of MCI and the cognitive function test results by Montreal cognitive assessment (MoCA) scale Chinese version, 80 volunteers receiving health check in our hospital from Nov. to Dec., 2019 were divided into MCI group (33 cases) and normal control (NC) group (47 cases). The demographic and clinical data were collected, and the blood glucose-related indexes, including 1,5-AG, fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c) and 2 h-postprandial glucose (2 h-PPG), were measured. Anxiety and depression were assessed by self-rating anxiety scale (SAS) and geriatric depression scale (GDS), respectively. Linear correlation analysis and multiple linear regression analysis were used to study the correlation between the blood glucose-related indexes and MCI. Results There were no significant differences in the demographic data, clinical data, SAS score or GDS score between the two groups (all P＞0.05). Compared with the NC group, the MoCA score and the level of 1,5-AG were significantly lower in the MCI group (P＜0.01, P＝0.023), and the levels of FPG and 2 h-PPG were significantly higher (P＝0.041, 0.027). Linear correlation analysis showed that the MoCA score was negatively correlated with the levels of FPG, 2 h-PPG and HbA1c (all P＜0.05), but not with 1,5-AG level (P＝0.134); the score of delayed recall, a cognitive domain of MoCA scale, was negatively correlated with the levels of FPG, 2 h-PPG and HbA1c (all P＜0.05), and positively correlated with the 1,5-AG level (P＝0.027). Multiple linear regression analysis showed that FPG was an independent factor of MoCA score (β＝－0.291, P＝0.009), and 1,5-AG and FPG were independent factors of delayed recall score (β＝0.199 and －0.390, P＝0.015 and 0.001). Conclusion 1,5-AG may be a potential biomarker for predicting cognitive impairment, especially for delayed recall; the blood glucose fluctuates greatly in MCI individuals at early stage, and maintaining the stability of blood glucose may be beneficial to the prevention of MCI.

Objective To analyze the imaging feature and misdiagnosis reason of pancreatic neuroendocrine neoplasm (pNEN) with pancreatic duct obstruction. Methods The data of 25 patients with pNEN accompanied by pancreatic duct obstruction who underwent surgical treatment in our hospital from Jun. 2012 to Oct. 2018 were retrospectively analyzed. The imaging findings and misdiagnosis reason of pNEN were summarized by two senior radiologists. Results A total of 26 lesions in 25 patients were included, including six G1 tumors, 19 G2 tumors and one G3 tumor. The average size of the lesions was (2.5±1.7) cm (range, 0.4-9.1 cm). Of the 26 lesions, the main pancreatic duct was mildly dilated in 12 cases (46.2%), moderately dilated in eight cases (30.8%), and severely dilated in six cases (23.1%). Seventeen (65.4%) lesions were accompanied by severe atrophy of the upstream pancreatic parenchyma, six (23.1%) by moderate atrophy, one (3.8%) by mild atrophy, and two (7.7%) with no atrophy. Before operation, 14 (53.8%) lesions were correctly diagnosed as pNEN; and eight (30.8%) lesions were misdiagnosed as pancreatic cancer, two (7.7%) as solid pseudopapillar tumor, one (3.8%) as intraductal papillary mucinous neoplasm and one (3.8%) as serous cystadenoma. The main reasons of misdiagnosis included atypical lesion manifestations, insufficient understanding of atypical manifestations of the disease, inadequate observation of image details, less consideration of clinical data of the patients, etc. Conclusion It is difficult to differentiate pNEN with pancreatic duct obstruction from other pancreatic tumors. Being familiar with the atypical manifestations of the lesion, observing the image details carefully and understanding clinical data with imaging findings can help to reduce misdiagnosis and improve the accuracy of diagnosis.

Objective To explore the application and clinical effect of ropivacaine incision infiltration combined with Wiltse approach in the analgesia of lumbar multi-segment decompression and fusion internal fixation. Methods A total of 120 patients with lumbar spinal stenosis and (or) lumbar disc herniation, who received posterior lumbar multisegmental (≥2) transforaminal lumbar interbody fusion (TLIF) in the Second Affiliated Hospital of Nantong University from Jan. 2016 to Jan. 2019, were randomly assigned to four groups: group A (ropivacaine incision infiltration＋Wiltse approach), group B (ropivacaine incision infiltration＋posterior median approach), group C (saline incision infiltration＋Wiltse approach) and group D (saline incision infiltration＋posterior median approach). The operation time, intraoperative blood loss, postoperative drainage volume, postoperative analgesic dosage, the visual analogue scale (VAS) score of low back pain before operation and 6 h, 1 d, 3 d, 7 d, 1 month and 3 months after operation, and the Oswestry disability index (ODI) before operation and 3 d, 7 d, 1 month and 3 months after operation, were compared among the four groups. Results There were no significant differences in gender, age, body weight, operative segments, low back pain VAS score or ODI before operation (all P＞0.05). The intraoperative blood loss, postoperative drainage volume and analgesic dosage were significantly lower in the groups A and C than those in the groups B and D (all P＜0.05). The VAS scores 6 h after operation were significantly lower in the groups A and B than those in the groups C and D, and the VAS scores 3 and 7 d after operation were significantly lower in the groups A and C than the groups B and D (all P＜0.05). The ODI values 3 d and 3 months after operation were significantly lower in the groups A and C than those in the groups B and D (all P＜0.05). Conclusion Preemptive analgesia using ropivacaine incision infiltration combined with Wiltse approach in lumbar multi-segment decompression and fusion internal fixation can effectively relieve postoperative pain, with remarkable analgesic effect and rapid functional recovery, benefiting early recovery of patients after operation.

Objective To investigate the distribution, drug resistance and molecular biological characteristics of carbapenem-resistant Klebsiella pneumoniae (CRKP) in our hospital, so as to provide reference for rational use of antibiotics and prevention and control of nosocomial CRKP infection. Methods Non-repetitive CRKP strains were collected from Jan. to Dec. 2019 in our hospital. VITEK 2 Compact automatic microbial analyzer and Kirby-Bauer test were used for bacterial identification and antimicrobial susceptibility analysis. WHONET 5.6 software was used to analyze CRKP detection rate, sample source and clinical department distribution. Hypermucoviscosity phenotype strains were screened by string test. Carbapenemase resistance genes, capsular serotype and virulence genes were detected by polymerase chain reaction (PCR). Results A total of 532 Klebsiella pneumoniae strains were detected, including 140 (26.3%) CRKP strains. The CRKP strains were mainly isolated from sputum and bronchoalveolar lavage fluid (66 strains, 47.1%), followed by urine (21 strains, 15.0%). The clinical departments of the isolates were mainly cardiovascular surgery intensive care unit (ICU) (47 strains, 33.6%), burn ICU (18 strains, 12.9%) and emergency department (18 strains, 12.9%). The antimicrobial susceptibility test showed that the CRKP strains were susceptible only to tigecycline, with resistance rates being over 50% to other common antibiotics. The resistance rates to the first to fourth generation cephalosporin antibiotics were above 85%, and the resistance rates to carbapenems were up to 100.0%. We also found that out of the 121 CRKP strains, 101 (83.5%) carried Klebsiella pneumoniae carbapenemase 2 (KPC-2) gene, seven (5.8%) with oxacillinase-48 (OXA-48) gene, and two (1.7%) with New Delhi metallo-β-lactmase 1 (NDM-1) gene; while one carried both KPC-2 and NDM-1 genes, and one carried both KPC-2 and OXA-48 genes; and nine carried no target drug-resistance genes. Fifteen (12.4%, 15/121) CRKP strains were positive for string test, with 13 being K64 capsular type and two being K47 capsular type; and 14 strains carried at least one virulence gene. Conclusion The clinical isolation rate of CRKP is high in our hospital, and the CRKP strains (mainly K64 capsular high virulence) are resistant to multiple antibiotics, suggesting that we should further strengthen the monitoring of drug resistance and rational use of antibiotics, so as to prevent the spread and prevalence of drug-resistant and highly virulent strains.

Objective To investigate the effects of spinal cannabinoid type 2 receptor (CB2R) and microglia activation on hyperalgesia in neuropathic pain mice. Methods Male C57/BL mice were randomly divided into six groups: sham, spinal nerve ligation (SNL), SNL＋CB2R agonist AM1241 (SNL＋AM1241), SNL＋microglia inhibitor minocycline (SNL＋minocycline), SNL＋small interfering RNA (siRNA) targeting CB2R (SNL＋siRNA), and SNL＋siRNA＋minocycline groups. A neuropathic pain mouse model was established by SNL. The expression levels of spinal CB2R and microglia-specific protein ionized calcium-binding adapter molecule 1 (IBA-1) were determined by Western blotting, mechanical pain thresholds were measured by Von Frey, spinal microglia activation was observed by IBA-1 immunofluorescence, and the expression levels of inflammatory factors in spinal cord dialysate were determined by quantitative real-time polymerase chain reaction (qRT-PCR). Electrophysiology was applied to observe the effect of CB2R agonist on spontaneous inhibitory postsynaptic current (sIPSC) in the spinal dorsal horn. Results Compared with the sham group, the expression of CB2R in spinal cord was significantly decreased in the SNL group (P＜0.012 5), the pain threshold was significantly reduced (P＜0.016 7), the fluorescence quantification and protein expression of IBA-1 were significantly increased (both P＜0.008 3), and the mRNA expression levels of tumor necrosis factor α (TNF-α), interleukin (IL)-1β and IL-6 were significantly increased (all P＜0.008 3). After intrathecal injection of CB2R agonist AM1241 or microglial inhibitor minocycline, compared with the SNL group, the pain thresholds of mice were significantly increased in the SNL＋AM1241 and SNL＋minocycline groups (both P＜0.008 3), the fluorescence quantification and protein expression of IBA-1 were significantly decreased (both P＜0.008 3), and the mRNA expression levels of TNF-α, IL-1β and IL-6 were significantly decreased (all P＜0.008 3). After targeted interfering CB2R expression by siRNA, compared with the SNL group, the pain threshold was significantly decreased in the SNL＋siRNA group (P＜0.008 3), the fluorescence quantification and protein expression of IBA-1 were significantly increased (both P＜0.008 3), and the mRNA expression levels of TNF-α, IL-1β and IL-6 were significantly increased (all P＜0.008 3); while intrathecal injection of minocycline significantly reversed the above changes (all P＜0.008 3). Intervention in vitro of AM1241 could significantly enhance the frequency and amplitude of sIPSC in the spinal dorsal horn (both P＜0.05), while continuous treatment with minocycline inhibited the enhancement effects of AM1241 on sIPSC. Conclusion CB2R can reduce the neuroinflammatory responses and enhance the inhibitory electrical activity in the spinal cord by inhibiting spinal microglia activation, thereby alleviating hyperalgesia of neuropathic pain in mice.