Background: Twenty-four-hour urinary free cortisol (UFC) measurement is the initial diagnostic test for Cushing’s syndrome (CS). We compared UFC determination by both direct and extraction immunoassays using Abbott Architect, Siemens Atellica Solution, and Beckman DxI800 with liquid chromatography-tandem mass spectrometry (LC-MS/MS). In addition, we evaluated the value of 24-hr UFC measured by six methods for diagnosing CS. Methods: Residual 24-hr urine samples of 94 CS and 246 non-CS patients were collected.A laboratory-developed LC-MS/MS method was used as reference. UFC was measured by direct assays (D) using Abbott, Siemens, and Beckman platforms and by extraction assays (E) using Siemens and Beckman platforms. Method was compared using Passing–Bablok regression and Bland–Altman plot analyses. Cut-off values for the six assays and corresponding sensitivities and specificities were calculated by ROC analysis. Results: Abbott-D, Beckman-E, Siemens-E, and Siemens-D showed strong correlations with LC-MS/MS (Spearman coefficient r = 0.965, 0.922, 0.922, and 0.897, respectively), while Beckman-D showed weaker correlation (r = 0.755). All immunoassays showed proportionally positive bias. The areas under the curve were 0.975 for Abbott-D, 0.972 for LCMS/MS, 0.966 for Siemens-E, 0.948 for Siemens-D, 0.955 for Beckman-E, and 0.877 for Beckman-D. The cut-off values varied significantly (154.8–1,321.5 nmol/24 hrs). Assay sensitivity and specificity ranged from 76.1% to 93.2% and from 93.0% to 97.1%, respectively. Conclusions Commercially available immunoassays for measuring UFC show different levels of analytical consistency compared to LC-MS/MS. Abbott-D, Siemens-E, and Beckman-E have high diagnostic accuracy for CS.

Objective:To evaluate the safety and efficacy of belimumab(BLM) in patients with SLE.Methods:Clinical data were collected for SLE patients who were diagnosed and treated with BLM in the Department of Rheumatology and Immunology (inpatient and outpatient department) of Guilin Medical College Affiliated Hospital from 1 December, 2019 to 12 May, 2023. BLM + standard of care (SOC) for the BLM group and SOC only for the SOC group. The primary clinical endpoint was adverse events (AE) occurring in groups, and the secondary clinical endpoint was disease activity index including SLEDAI-2000, clinical indicators, glucocortoid dosage reduction, and disease flare in the two groups. Propensity score matching method, independent sample t-test, non-parametric rank-sum test, variance analysis were used for statistical analysis. Results:Among the 79 BLM patients included, 48 had hematological impairment (61%), 53 had renal impairment (67%), 11 had skin and mucosal impairment (14%), 20 had joint impairment (25%), and 2 had neurological impairment(3%). There were no serious adverse events during the treatment in both groups. In the BLM group, with 14 cases experienced respiratory system infection, 1 with urinary system infection, 3 with skin infection, 4 with herpes virus infection, and 16 with liver function impairment. In the SOC group, there were 26 cases experienced respiratory system infection, 1 with urinary system infection, 6 with digestive system symptoms, 6 with skin infection, 4 with herpes virus infection, 10 with liver function impairment, 2 with thrombosis, and 1 with sepsis. Patients tolerated BLM generally well, with fewer adverse events occurring [in patients with the long course treatment, the number of AE cases in the BLM group vs SOC group 11 [(33%) vs 22 (68%), ( χ2=3.74, P=0.053)]. From all study groups and high-dose glucocorticoid (≥20 mg) groups, it was observed that the BLM group had a more significant reduction in glucocortoid dose [baseline glocucorticoid reduction in the BLM group decreased from 20 (12, 40)mg/d to 6 (4, 10)mg/d ( Z=0.12, P=0.01). In the renal injury group, after treatment, serum creatinine level decreased in the BLM group glomerular filtration rate increased from 72.37 (41.97, 95.74) to 97.03 (71.18, 114.34) ( Z=-4.62, P<0.001). There was less flares in the BLM group [7 cases (28%) vs 18 cases (72%), χ2=5.58, P=0.018] when compared with the soc group. Conclusion:BLM is safe and effective for the treatment of SLE, which can reduce disease activity, improve clinical parameters, reduce glocucorticoid dosage, and have a low flare rate.

Objective:To study the risk factors of extrauterine growth retardation (EUGR) during hospitalization in very preterm infants (VPIs) with birth weight (BW) <1 500 g.Methods:From Jan 2015 to Dec 2020, clinical data of VPIs admitted to neonatal department our hospital were retrospectively studied. The infants were assigned into EUGR group and non-EUGR group according to their weight at discharge. Multivariate logistic regression analysis was used to analyze the risk factors of EUGR in VPIs.Results:A total of 969 VPIs were enrolled, including 400 cases of EUGR (41.3%). Multivariate logistic regression analysis showed that Z-score of BW ( OR=0.057, 95% CI 0.037-0.088, P<0.001) was closely correlated with the occurrence of EUGR and growth velocity (GV) after regain BW ( OR=0.537, 95% CI 0.479-0.602, P<0.001) was a protective factor for EUGR. Maternal hypertension during pregnancy ( OR=1.895, 95% CI 1.059-3.394, P=0.031), asphyxia at birth ( OR=2.508, 95% CI 1.265-3.347, P=0.004) and moderate to severe bronchopulmonary dysplasia (BPD) ( OR=2.660, 95% CI 1.503-4.708, P=0.001) were risk factors for EUGR at discharge. Conclusions:EUGR is still common in VPIs. Increased GV after regain BW, prevention and treatment of moderate to severe BPD may reduce the incidence of EUGR at discharge in VPIs.

Objective:To search, evaluate and integrate the best evidence of exercise rehabilitation intervention after PCI in patients with acute myocardial infarction, so as to provide evidence-based basis for clinical doctors and nurses to intervene in exercise rehabilitation of patients.Methods:We searched PubMed, China National Knowledge Infrastructure, Wanfang Data and other domestic and foreign databases, guide websites and professional association websites about the evidence of exercise rehabilitation intervention in patients with acute myocardial infarction after PCI. The search period is from January 2010 to June 2021. The quality of the included literature was evaluated by two researchers, and the literature evidence in accordance with the quality standard was extracted.Results:A total of 20 articles were included, and 39 pieces of evidence were summarized from 11 aspects, such as the establishment of multidisciplinary team, evaluation, exercise prescription, exercise monitoring and so on.Conclusions:This study summarized the best evidence of exercise rehabilitation intervention in patients with acute myocardial infarction after PCI, and provided theoretical support for clinical practice. It is suggested to combine the clinical situation and patients' wishes to promote the transformation of the best evidence to clinical practice.

Objective: To investigate risk perception, emergency preparedness and emergency literacy among medical students under COVID-19 epidemic. Methods: An online survey was conducted by using the self designed COVID-19 questionnaire on risk perception, emergency preparedness and emergency literacy from March 27 to March 30, 2020. The convenience sampling method was used to investigate 4 864 medical students from 2 colleges and technical secondary schools in Sichuan Province. Results: The scores of risk perception, emergency preparedness and emergency literacy associated with COVID-19 were(35.18±4.33)(28.30±4.16) and(25.23±2.97) respectively. Risk perception of medical students was positively correlated with emergency preparedness and emergency literacy(r=0.35, 0.40), emergency preparedness was positively correlated with emergency literacy(r=0.51)(P<0.05). Conclusion Considering interrelationships among risk perception, emergency preparedness and emergency literacy associated with COVID-19, medical students should be given targeted prevention and control training.

Objective: By comparing different repairing effects of different methods on articular cartilage defects in rabbit model, the ability of a new bioactive glass scaffold to repair cartilage defect was studied. Methods: We prepared the PSC/CS bone cement by mixing the bioactive glass (BG) powder composed of 10.8%P₂O₅-54.2%SiO₂-35%CaO (PSC), chitosan solution (CS) and calcium sulfate hemihydrate (CSH), then the bone cement was sized by a mold to form cylindrical scaffold. In vivo experiment, 18 male rabbits were divided into three groups randomly, including blank group, BG group and TGF-β1 group, which was added TGF-β1 into BG scaffold. Both knees of each rabbit were made cartilage defect for the same group, and no intervention was applied in B group, then implanted scaffolds into defects in both experimental groups. At 6 and 12 weeks after surgery, observed the macroscopic growth, histologic staining and collagen II immunohistochemistry (IHC), and the International Cartilage Repair Society (ICRS) and Wakitani score were used to analyze the experimental results quantitatively. Results: At 6 weeks after surgery, there was no obvious difference between blank group and BG groups, but the macroscopic result of TGF-β1 group was better than the other two groups and its ICRS score 4.67±0.52 points was statistically higher than BG group 2.83±0.75 points (t=-2.817, P=0.015). As to the comparison of histologic staining and Wakitani socre among three groups, no statistical difference was observed (blank group=13.67±0.52, BG group=13.83±0.41, TGF-β1 group=13.33±1.03). At 12 weeks after surgery, there was still no obvious difference between blank and BG groups, while the results of macroscopic observation and ICRS score in TGF-β1 group were significantly higher than them 9.01±0.63 points (blank group vs TGF-β1 group: t=-2.289, P=0.022; BG group vs TGF-β1 group: t=-2.326, P=0.020). More importantly, much deeper positive staining were observed in TGF-β1 group, and the Wakitani score was higher than the other two groups (blank group=9.83±1.33, BG group=9.51±1.05, TGF-β1 group=6.50±1.38, blank group vs TGF-β1 group: t=-2.771, P=0.007; BG group vs TGF-β1 group: t=-2.756, P=0.006). By comparing the degree of histologic staining and Col II expression with normal cartilage, the regenerated tissue in TGF-β1 group was similar. Conclusion Single PSC/CS scaffold doesn’t possess excellent ability to repair cartilage defect. When TGF-β1 was added into PSC/CS bioactive glass, the scaffold was able to promote cartilage defect repair, and the regenerated tissue was similar to normal cartilage.

Objective To translate the Water Orientation Test of Alyn 2 (WOTA2) into Chinese, and to study its reliability and validity for patients with spinal cord injury. Methods After authorizing, the English version WOTA2 scale and its training package were translated into Chinese. From January to September, 2018, 137 patients with spinal cord injury were evaluated with the Chinese version WOTA2 by two evaluators independently, and evaluated again three days later by one of the evaluators. The Cronbach's α, Spearman-Brown coefficient, intra-group correlation coefficient (ICC) and Kappa coefficient were calculated to evaluate the reliability. Content Validity Index (CVI) of items (I-CVI) and scale (S-CVI) were used to evaluate the content validity, and factors analysis was used to evaluate the structure validity. Results The Cronbach's α was 0.947 in all items of the scale, 0.890 in mental adjustment items and 0.954 in aquatic skills items. Pearson correlation coefficient of the half scales separated by odd and even items was 0.948, and the Spearman-Brown coefficient was 0.973. The ICC of test-retest was 0.965 in total score, 0.965 in centesimal system total score, 0.847 in mental adjustment score and 0.970 in aquatic skills score. The ICC of inter-testers was 0.964 in total score, 0.965 in centesimal system total score, 0.847 in mental adjustment score and 0.970 in aquatic skills score. The Kappa coefficient was 0.528 to 0.927 in test-retest and 0.528 to 0.927 in inter-testers. The I-CVI was 0.8 to 1.0 and S-CVI was 0.63. Factors analysis extracted four factors, which met the theory, and contributed 67% of cumulative variance. Conclusion The Chinese version WOTA2 is good in reliability and validity for patients with spinal cord injury, and can be used in the clinical practice of aquatic therapeutic exercise in China.

Objective To verify the mediating effect of the moral identity on the relationship between sport moral disengagement and pro-social and anti-social behaviors in competition.Methods Two hundreds and sixty-seven athletes of group events(including 173 males,94 females,with an average age of 22.40,SD=2.75)were selected and investigated using the sport moral disengagement scale,moral identity scale and the scale of pro-social and anti-social behavior in competition.Results (1) The sport moral disengagement had significant influence on the athletes'pro-social and anti-social behaviors in competition.(2)The moral identity has significant positive influence on the athletes' pro-social behavior in competition,but significant negative influence on the athletes' anti-social behavior in competition.(3)The moral identity has significant mediating effect on the relationship between sport moral disengagement and pro-social behavior in competition.Conclusion The moral disengagement in sport has important influence on the athletes' pro-social and anti-social behavior in competition.The moral identity has a significant mediating effect on the relationship between sport moral disengagement and pro-social behaviors in competition.

Aim To investigate the relationship between the brain targeting effect and P-glycoprotein(P-gp)expression level of Danshensu borneol ester(DBE)and the combination use of sodium Danshensu and borneol(SDSS-B).Methods The liquid chromatography mass spectrometry(LC-MS)method was applied to investigate the accumulation of Danshensu(DSS)in rat brain tissues after intravenous injection of DBE,SDSS-B and SDSS.Also their effect on regulating the expression level of P-gp in rat hippocampus was investigated using Western blot.Results The brain targeting effect of DBE,SDSS-B was qualitatively analyzed through the brain distribution of DSS,and the result was DBE(SDSS-B)>SDSS(P<0.01).Meanwhile,the brain distribution of DBE group was slightly lower than SDSS-B group at 15 min,while at 30 min DBE was higher than that of SDSS-B.DBE demonstrated a better slow release property compared to SDSS-B.Western blot analysis indicated that DBE,SDSS-B were more effective in inhibiting the expression of P-gp than SDSS in rat hippocampus(P<0.01 vs control or SDSS group),and the lowest P-gp expression was obtained with(47.58±2.28)％and(46.54±1.41)％at 45 min after administration of DBE or SDSS-B.Once the administration time was extended to 60 min,the inhibitory effect on P-gp expression of DBE was stronger than SDSS-B[(85.04±1.42)％vs(95.29±0.98)％].However,no significant inhibition of P-gp expression in rat hippocampus was found throughout the treatment of SDSS(P>0.05 at 5,15,45,60 min,vs control group).Conclusion An attenuated expression level of P-gp can be realized by DBE and SDSS-B,which is advantageous to their brain targeting.

Objective To evaluate the value of captopril challenge test (CCT) in the diagnosis of primary aldosteronism (PA).Methods A total of 674 patients [(45.0±13.7) years, men 341, women 333] admitted to Peking Union Medical College Hospital from 2000 to 2015 were analyzed.Among them, 222 subjects were with essential hypertension (EH), 28 were with pheochromocytoma (PHEO), 246 were with idiopathic hyperaldosteronism (IHA) and 178 were with aldosterone producing adenoma (APA).All patients received CCT.24 h urine sodium was measured in partial patients.Plasma renin activity (PRA), aldosterone (ALD) were detected.Results Compared with EH [PRA: before 0.5(0.2,0.9) μg·L-1·h-1, after 0.8(0.4,1.5) μg·L-1·h-1;ALD: before (393±122) pmol/L, after (360±97) pmol/L] and PHEO [PRA: before 0.3(0.1,0.9) μg·L-1·h-1, after 0.4(0.1,1.6) μg·L-1·h-1;ALD: before (396±108) pmol/L, after (374±114) pmol/L], lower levels of PRA and higher levels of ALD before and after CCT were observed in PA patients [PRA: before 0.1 (0.1,0.2) μg·L-1·h-1, after 0.1 (0.1,0.2) μg·L-1·h-1;ALD: before (468±216) pmol/L;after (457±199) pmol/L].After CCT, the suppression rate of ALD [2.8% (-8.8%,15.4%) vs 6.6% (-4.3%, 17.6%)] and increasing rate of PRA [0(0,50%) vs 50%(0, 200%)] in PA patients were lower than those in EH patients.The ALD/PRA ratio (ARR) were higher in PA than that in EH or PHEO patients.In the EH subjects, ALD levels of seated posture were higher than those of recumbent posture both before and after receiving captopril, but with no changes in ARR after CCT.No significant differences in ALD and ARR (before and after receiving captopril) were observed between seated and recumbent position in the PA group.The ARR after CCT tended to decrease in EH subjects with elevated urine-sodium compared with those with normal urine-sodium.No changes could be viewed in ALD and PRA levels between normal urine-sodium and elevated urine-sodium groups among APA, IHA and EH patients either before or after CCT.Among patients with APA, the ALD levels before CCT and the ARR after CCT were lower in the patients with AngiotensionⅡ(AngⅡ) reactive than those without.A ROC curve analysis suggested that the optimal cutoff value was 46.2 (ALD unit:ng/dl;PRA unit:μg·L-1·h-1) for ARR after challenge in diagnosing PA, with the sensitivity of 88.7% and specificity of 84.8%.Conclusions ARR after 25 mg captopril had high sensitivity and specificity in diagnosis of PA with the cutoff of 46.2.Seated CCT could replace recumbent CCT as a more confirmatory test.The PRA increasing rate should be taken into consideration when diagnosis of PA.